Glaucoma

• Glaucoma


  An eye disorder characterized by increased intraocular pressure (IOP); visual loss is irreversible
• Types of Glaucoma

  Angle-Closure - acute
• Types of Glaucoma

  Angle-Closure - blocked angle caused by the iris
• Types of Glaucoma

  Angle-Closure - emergency
• Types of Glaucoma

  Angle-Closure - onset of pain is sudden
• Types of Glaucoma

  Angle-Closure - blurred vision; halos around light
• Types of Glaucoma

  Open-Angle - Chronic
• Types of Glaucoma

  Open-Angle - partial block of the trabecular meshwork
• Types of Glaucoma

  Open-Angle - onset of pain is insidious, at times there may be NO pain
• Types of Glaucoma

  Open-Angle - Fixed, dilated pupil
• Types of Glaucoma

  Open-Angle - slow changes in vision
• Types of Glaucoma

  Open-Angle - tunnel vision/loss of peripheral vision
• Glaucoma

  s/sx: Pain in the eye especially in the morning (acute)
• Glaucoma

  s/sx: loss of peripheral vision (tunnel vision)
• Glaucoma: Diagnostics

  Tonometry - increase IOP; >25 mmHg
• Glaucoma: Diagnostics

  Perimetry - decrease peripheral vision
• Glaucoma: Diagnostics

  Gonioscopy - obstruction in the anterior chamber
• Glaucoma Management:

  • Activity: Bed Rest
  • Room: Quiet, darkened
  • HOB: Elevated
  • Administer Miotics - constrict the pupils, permits drainage of aqueor's humor, maintain drug (LIFETIME)
  • Administer Acetazolamide - diuretic to reduce aqueous humor
  • Administer Timolol - beta-blocker to reduce aqueous humor
• AVOID Mydriatic drugs for Glaucoma:

  • Atropine
  • Benadryl
  • Cogentin
• Glaucoma Surgical Management

  Laser Trabeculoplasty

  • For open angle glaucoma; laser beam is applied to the inner surface of the trabecular meshwork to open the intratrabecular spaces
• Glaucoma Surgical Management

  Laser Iridotomy

  • For close angle glaucoma; an opening is made in the iris to eliminate the pupillary block
• Glaucoma Surgical Management

  Trabeculectomy - remove part of the meshwork
• Glaucoma Surgical Management

  Position after surgery: Semi-fowler’s (prevent increase in IOP); side-lying on unaffected side
• Additional on Meds:

  (+) Prostaglandins - "prost"

  • enhance outflow of aqueous humor
  • SE: thickened, longer lashes; dark eye color
  • increase outflow of AH = decrease IOP