Glaucoma

Eye disease in which the optic nerve is damaged in a characteristic pattern. This can permanently damage vision in the affected eye(s) and lead to blindness if left untreated. It is normally associated with increased fluid pressure in the eye (aqueous humour).

Glaucoma

Normal intraocular pressure ranges from 12 to 20 mm Hg A patient with an IOP of 28 mm Hg is about 15 times more likely to develop field loss than a patient with a pressure of 22 mm Hg

Elevated IOP

Ischemi a to the optic nerve

Pressure on the retina & optic nerve

Vision loss

Total blindness

Primary Glaucoma Glaucoma is said to be primary if there is no definitive cause of the glaucoma. Secondary glaucoma Occurs because of another condition, such as ocular trauma, prolonged use of steroids, tumors, or an inflammatory process of the eye.

Open angle glaucoma

It is believed that there is an impairment of aqueous humor flow through the trabecular network, which leads to an increase in intraocular pressure.

Most commonly seen in the 6th decade of life

Open angle glaucoma

The bad thing about this type of glaucoma, is that the individual ends up with permanent vision damage since there are no early warning signs.

The key is regular screening for increasing intraocular pressure.

Closed angle glaucoma

Closed-angle glaucoma results when the pupil and lateral cornea angle narrow to a point where there is a decrease in aqueous humor flow out of the anterior chamber.

Considered a medical emergency because vision loss can occur within 24 hours of symptoms.

Closed angle glaucoma

When an individual has closed-angle glaucoma, pupil dilation can be dangerous due to the sudden increase in intraocular pressure.

Immediate treatment is required.

CAUSES OF GLAUCOMA
1. Age - especially after age 60, is the number one risk factor for the formation of glaucoma. African American risk starts rising after the age of 40. 2. Race - Those of African American, Mexican-American, or Asian-American descent are at greater risk than Caucasians to develop glaucoma.

Causes of glaucoma
3. Family history of glaucoma 4. Medical conditions - diabetes, uncontrolled hypertension, heart disease, and hypothyroidism. Regular coffee ingestion has also been implicated in slightly increasing a persons intraocular pressure. 5. Physical injuries - Eye trauma, especially if severe, can cause an increase in eye pressure. The lens of the eye can also become dislocated, which can result in closing the drainage angle.

Causes of glaucoma
6. Corticosteroid use - Prolonged use of corticosteroids increases a persons risk for developing secondary glaucoma.
7. Near-sightedness 8. Eye abnormalities

SIGNS AND SYMPTOMS

A. OPEN ANGLE GLAUCOMA

No symptoms - the individual may not even be aware that a problem has started with an increase in IOP that will eventually lead to optic nerve damage.

A. OPEN ANGLE GLAUCOMA

Loss of peripheral vision - The pressure compresses on the optic nerve and a decrease in oxygen supply occurs. Nerve damage results if left untreated. Eventually, the person loses peripheral vision.

A. OPEN ANGLE GLAUCOMA

A. OPEN ANGLE GLAUCOMA

Tunnel vision and eventually blindness As glaucoma persists, more pressure is exerted on the optic nerve to the point that tunnel vision occurs. Total death of the optic nerve causes blindness. Glaucoma can occur in one or both eyes.

B. CLOSED-ANGLE GLAUCOMA

Sudden, severe eye pain - Increased intraocular pressure occurs suddenly, causing a sudden onset in eye pain. The eye does not have time to compensate when pressure goes up rapidly. This most often occurs when the person is sitting in a dark room, which causes the eyes to dilate. The angle diminishes, thus diminishing or occluding the flow of aqueous humor.

B. CLOSED-ANGLE GLAUCOMA

Blurred vision - It is the buildup of pressure within the eye and around the optic nerve that causes vision to become blurred.

B. CLOSED-ANGLE GLAUCOMA

Halos around lights - it is the buildup of pressure within the eye and around the optic nerve that causes the person to see halos.

Nausea and vomiting - Severe pain can stimulate the vomiting center Hard eye to palpation - Increased pressure from fluid

DIAGNOSIS

GLAUCOMA TESTS
Tonometry (Tests for inner Eye Pressure) The eye is numbed via eye drops. The examiner then uses a tonometer to measure the inner pressure of the eye through pressure applied by a warm puff of air or a tiny tool.

GLAUCOMA TESTS
Ophthalmoscopy (Tests for shape and Color of the Optic Nerve)
The

pupil is dilated via the application of eye drops. Using a small magnification device with a light on the end, the examiner can examine the magnified optic nerve.

GLAUCOMA TESTS
Perimetry (Test for Complete Field of Vision) The patient looks straight ahead and is asked to indicate when light passes the patients peripheral field of vision. This allows the examiner to map the patients field of vision.

GLAUCOMA TESTS
Gonioscopy (Tests for Angle in the Eye Where the Iris Meets the Cornea) Rules out angle-closure or secondary causes of IOP elevation, such as angle recession, pigmentary glaucoma.

GLAUCOMA TESTS
Pachymetry (Tests for Thickness of the Cornea) According to the OHTS, pachymetry is now the criterion standard for every baseline examination in patients who are at risk for or suspected of having glaucoma.

GLAUCOMA TESTS
Nerve Fiber Analysis (Tests for Thickness of Nerve Fiber Layer) Using one of several techniques, the nerve fibers are examined.

Medications

Prostaglandin analogs, such as latanoprost (Xalatan), bimatoprost (Lumigan) and travoprost (Travatan), increase uveoscleral outflow of aqueous humor. Bimatoprost also increases trabecular outflow.

Medications
Beta-adrenergic blockers. Topical beta-adrenergic receptor antagonists decrease aqueous humor production by the ciliary body. Adverse effects are due to systemic absorption of the drug, decreased cardiac output, and bronchoconstriction. e.q. timolol

Medications
Adrenergic agonists Alpha2-adrenergic agonists work by decreasing aqueous production. Systemic adverse effects include dry mouth, fatigue, and drowsiness. Ocular adverse effects include allergic (follicular) conjunctivitis and contact dermatitis. e.q. brimonidine

Medications
Carbonic anhydrase inhibitors. Reduce secretion of aqueous humor by inhibiting carbonic anhydrase (CA) in the ciliary body. These drugs are less effective, and their duration of action is shorter than many other classes of drugs. e.q.acetazolamide

Medications
Miotic agents (parasympathomimetics) Miotics work by contraction of the ciliary muscle, tightening the trabecular meshwork and allowing increased outflow of aqueous through traditional pathways. e.q. pilocarpine

Medications
Hyperosmotic agents. These agents are used infrequently, most commonly to reduce extremely elevated IOP in acute situations of angle-closure or certain secondary glaucomas, or selectively as a preoperative measure before intraocular surgery. e.q. E.q. mannito, glycerin

Glaucoma facts
IOP is not helpful diagnostically until it reaches approximately 40 mm Hg at which level the likelihood of damage is significant. Visual fields are also not helpful in the early stages of diagnosis because a considerable number of neurons must be lost before VF changes can be detected.

Glaucoma facts

Optic nerve damage in the early stages is difficult or impossible to recognize.

50% of people with glaucoma do not know it!

Intraocular pressure is not the only factor responsible for glaucoma!

95% of people with elevated IOP will never have the damage associated with glaucoma. One-third of patients with glaucoma do not have elevated IOP. Most of the ocular findings that occur in people with glaucoma also occur in people without glaucoma.

What can harm the client?

1. Glaucoma will not kill the client; however, it can greatly alter your patients quality of life. 2. With diminished vision or blindness, a person is at greater risk for encountering home and environmental hazards. 3. Operating hazardous machinery, such as driving a car, can put the patient at risk for an automobile accident.

What can harm the client?

4. Remember, the person with glaucoma does not have peripheral vision. So, the key here is education in order to promote safety 5. Infection after surgery 6. Choroids hemorrhage or detachment after surgery as evidenced by eye pain, decreased vision, and changes in vital signs 7. Never give atropine to anyone with glaucoma.

CLIENT EDUCATION

1. Promoting regular eye exams, since this is the key to early detection. Ophthalmologists recommend routine eye checkups every two to four years after age 40 and every one to two years after age 65.

CLIENT EDUCATION
2. Teach individuals at risk for glaucoma development to be alert for signs or symptoms of an acute angle-closure glaucoma attack. Signs and symptoms include severe headache or eye pain, nausea, blurred vision, or halos around lights. Emergency care is needed if any of these occur.

CLIENT EDUCATION
3. Clients at risk should understand that there is no proven method to prevent glaucoma.

4. Once diagnosed with glaucoma, it is important for the patient to understand the importance of taking glaucoma medication every day exactly as prescribed in order to reduce intraocular pressure.

Other recommended educational points to teach the client about are:

Maintain a healthy diet. Fruits and vegetables provide important nutrients for the eyes, which include vitamins A, C, and E; zinc; and copper. Limit caffeine intake.

Other recommended educational points to teach the client about are:

Exercise regularly. Exercising three times a week may decrease intraocular pressure for the person who has openangle glaucoma. The other forms of glaucoma, however, are not generally affected by exercise. Stress in patients who do yoga and other exercises that put the head in a dependent position might actually increase intraocular pressure.

Other recommended educational points to teach the client about are:

Avoid stress. Stress can precipitate an acute attack of closed-angle glaucoma. Teach the patient relaxation techniques such as relaxation and biofeedback. Wear proper eye protection. Eye trauma can increase intraocular pressure. Stress the importance of eye safety when playing sports or when using tools and machinery. Wearing safety goggles can prevent eye injury.