OM VERMA ASSOCIATE PROFESSOR GRACIOUS COLLEGE OF NURSING ABHANPUR RAIPUR C.G

1. GRACIOUS COLLGE OF NURSING
ABHANPUR , RAIPUR
GLAUCOMA
GLAUCOMA
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR

2. Pressures of between 11 and
21 mmHg are considered
normal, can exceed 70 mm Hg
normal, can exceed 70 mm Hg
in some glaucoma's.

3. DEFINITION

4. DEFINITION
“A disease of the eye in which the pressure of
fluid inside the eyeball is abnormally high,
caused by obstructed outflow of the fluid.
The increased pressure can damage the optic
The increased pressure can damage the optic
nerve and lead to partial or complete loss of
vision.”
According to luckmans

5. DEFINITION
Glaucoma is a group of ocular conditions
characterized by optic nerve damage. The
optic nerve damage is related to the intra
ocular pressure (IOP) caused by congestion
ocular pressure (IOP) caused by congestion
of aqueous humor in the eye.
According to Brunner & Suddarth’s

6. TYPES

7. CONGENITAL
It is characterized by elevation of intra ocular
pressure (IOP) associated with developmental
abnormalities of the angle of anterior chamber
depending upon the age of onset.
This developmental glaucoma's are termed as :
1. True or primary congenital glaucoma (IOP is raised
during intrauterine life)
2. Infantile glaucoma's (Diseases manifests prior to the
child)
3. Juvenile glaucoma (Children develop IOP pressure
rise between 3-16 yrs of life)

8. ACQUIRED
Glaucoma is defined as an acquired
loss of retinal ganglion cells and
axons within the optic nerve or optic
neuropathy that results in a
neuropathy that results in a
characteristic optic nerve head
appearance and a corresponding
progressive loss of vision.

9. ACQUIRED –
1. PRIMARY
2. SECONDARY
2. SECONDARY

10. ACQUIRED –
1. PRIMARY DIVIDED 2 TYPES
• Open angle/ Wide angle/ Chronic
• Angle Closure/Narrow angle/Closed
angle

11. OPEN ANGLE GLAUCOMA
1. Primary chronic open angle glaucoma
(COAG)
2. Normal tension (pressure) glaucoma or
low tension glaucoma
3. Childhood glaucoma
4. Secondary open angle glaucoma
5. Pigmentary glaucoma
6. Exfoliative glaucoma

12. OPEN ANGLE GLAUCOMA
1.Primary chronic open angle glaucoma
(COAG)
• It is the most common type of the
glaucoma. Its frequency increases greatly
with age. The aqueous fluid does not drain
with age. The aqueous fluid does not drain
from the eye properly. The pressure within
the eye, therefore, builds up painlessly and
without symptoms.
•

13. OPEN ANGLE GLAUCOMA
2. Normal tension (pressure) glaucoma or
low tension glaucoma :-
• This type of glaucoma is thought to be due
to decreased blood flow to the optic nerve.
This condition is characterized by
This condition is characterized by
progressive optic-nerve damage and loss of
peripheral vision (visual field) despite
intraocular pressures in the normal range or
even below normal.

14. OPEN ANGLE GLAUCOMA
3. Childhood glaucoma :-
• Childhood glaucoma is an uncommon
pediatric condition often associated with
significant visual loss.Itmay most commonly
significant visual loss.Itmay most commonly
be caused by trauma, surgery or other
acquired or secondary causes or abnormal
increase intra ocular pressure.

15. OPEN ANGLE GLAUCOMA
4. Secondary open angle glaucoma :-
• It can result from an eye (ocular)
injury,inflammation in the iris (iritis),retinal
injury,inflammation in the iris (iritis),retinal
vein blockage etc.

16. OPEN ANGLE GLAUCOMA
5. Pigmentary glaucoma :-
• In thisgranules of pigment detach from
theiris,which is the colored part of the
eye.These granules then may block the
trabecular meshwork, is a key element in
trabecular meshwork, is a key element in
the drainage system of the eye.Finally the
blocked drainage system leads to elevated
intraocular pressure which results in
damage to the optic nerve.

17. OPEN ANGLE GLAUCOMA
• Exfoliative glaucoma :-
• This type of glaucoma is characterized by
deposits of flaky material on the front
surface of the lens (anterior capsule) & in
the angle of the eye.The accumulation of
the angle of the eye.The accumulation of
this material in the angle is believed to
block the drainage system of the eye and
raise the eye pressure.

18. ANGLE CLOSURE GLAUCOMA
1. Acute angle closure glaucoma
2. Chronic angle closure glaucoma

19. Angle-closure glaucoma
• Angle-closure glaucoma may be acute or
chronic.The common element in both is
that all of the drainage angle becomes
anatomically closed,so that the aqueous
anatomically closed,so that the aqueous
fluid within the eye cannot even reach all
or part of the trabecular meshwork.

20. 1. Acute angle closure glaucoma
• When the drainage angle of the eye suddenly
becomes completely blocked,pressure builds
up rapidly, and this is called acute angle-
closure glaucoma. The symptoms include
closure glaucoma. The symptoms include
Acute angle-closure glaucoma presents as a
sudden onset of severe unilateral eye pain or
a headache associated with blurred vision,
rainbow-colored halos around bright lights,
nausea, and vomiting.

21. 2. Chronic angle closure glaucoma :-
• Chronic closed-angle glaucoma, also called chronic
angle-closure glaucoma, is a condition that can be a
cause of permanent vision loss if not diagnosed and
managed correctly. When the drainage angle of the
eye gradually becomes completely blocked, pressure
eye gradually becomes completely blocked, pressure
builds up gradually, and this is called chronic angle-
closure glaucoma. The drainage tissues gradually start
to scar. This condition is generally silent, and severe
glaucoma damage can occur without the person's
knowledge.
•

22. ETIOLOGY
1
Antihistamines

23. SLEEP APNEA
• sleep apnea: it tends to take longer for your
tears to be replenished, you're more likely to
have ocular irritation suffer from sleep apnea
are more likely to develop glaucoma low
are more likely to develop glaucoma low
oxygen concentration in the blood may
contribute to degradation of the optic nerve,
potentially leading to glaucoma.

24. Antihistamines drug used
• Many oral antihistamines have been
implicated in acute angle closure attacks in
patients with narrowed aqueous
circulation (e.g., narrow-angle glaucoma)
circulation (e.g., narrow-angle glaucoma)

25. RISK FACTORS

26. CLINICAL MANIFESTATION

27. PATHOPHYSIOLOGY :-
1. Initiating Events :- Precipitating factors include
illness,emotional stress,congenital narrow angles,
long term use of corticosteroids & mydriatics
(medications causing papillary dilation).These
events lead to second stage.
events lead to second stage.
2. Structural alterations in the aqueous outflow
system :- Tissue & cellular changes caused by
factors that affect aqueous humor dynamics lead
to structural alterations & to the third stage.

28. 3. Functional alterations :- Conditions such as
increased IOP or impaired blood flow create
functional changes that lead to fourth stage.
4. Optic nerve damage :- Atrophy of the optic
nerve is characterized by loss of nerve fibers &
blood supply & this fourth stage inevitably
blood supply & this fourth stage inevitably
progresses to the fifth stage.
5. Vision loss :- Progressive loss of vision is
characterized by visual field defects.

29. • ASSESSMENT & DIAGNOSTIC
EVALUATION

30. ASSESSMENT & DIAGNOSTIC
EVALUATION
1. History taking
2. Tonometry
3. Ophthalmoscopy
4. Gonioscopy
4. Gonioscopy
5. Perimetry
6. Pachymetry
7. Dilated pupil
examination

31. • Optical coherence tomography (OCT) The
noninvasive method produces an image by
measuring the amount of a dim red light that
reflects off of retina and optic nerve. Optical
reflects off of retina and optic nerve. Optical
coherence tomography can measure the
thickness of retina and optic nerve. to look for
changes in your optic nerve that may indicate
glaucoma.

32. • Ophthalmoscopy is an examination of the
back part of the eye (fundus), which includes
the retina , optic disc, choroid , and blood
vessels.
• A perimetry test can help find certain
patterns of vision loss. This may mean a
certain type of eye disease is present. It is very
useful in finding early changes in vision caused
by nerve damage from glaucoma

33. • Ocular pressure test (tonometry) to measure
eye pressure.
• Pachymetry to measure corneal thickness.
• Slit-lamp exam to examine the inside of your
eye with a special microscope called a slit
lamp.
lamp.
• Visual acuity test (eye charts) to check for
vision loss.
• Dilated eye exam to widen pupils and view
your optic nerve at the back of your eyes.

34. PHARMACOLOGICAL MANAGEMENT
1. Cholinergics (Miotics): Pilocarpine,Carbachol
(1%,2% or 4%/3-4 times/day)-It increases
aqueous fluid outflow by contracting the ciliary
muscles & causing constriction of the pupil &
opening of the trabecular meshwork.
opening of the trabecular meshwork.
2. Adrenergic agonists : Dipivefrin,Epinephrine
(0.5%, 1% or 2%/1-2 times/day)-Reduces
production of aqueous humor & increases outflow.

35. 3. Beta blockers : Betaxolol,Timolol (0.25 or
0.5%/2 times/day)-Decreases aqueous humor
production.
4. Alpha adrenergic agonists : Apraclonidin,
Brimonidine (0.5%/2-3 times/day)-Decreases
Brimonidine (0.5%/2-3 times/day)-Decreases
aqueous humor production.
5. Carbonic anhydrase inhibitors :
Acetazolamide, methazolamide (250 mg / tds
Decreases aqueous humor production.

36. SURGICAL MANAGEMENT

37. :-
( for papillary block glaucoma)

38. 3. Filtering procedures :- To
create an opening or fistula in
the trabecular meshwork to
drain aqueous humor.
4. Trabeculectomy :- It is the
standard filtering technique
used to remove part of the
trabecular meshwork.

39. • . 5. Drainage implants or shunts :- an open
tubes implanted in the anterior chamber to
shunt aqueous humor to an attached place in
the conjunctival space
• A fibrous capsule develops around the
episcleral plate & filters the aqueous
humor,thereby regulating the outflow &
humor,thereby regulating the outflow &
controlling IOP.

40. 6. Canaloplasty :- a micro-
catheter or tube placed in the Canal of
Schlemm (the natural
site of drainage for healthy eyes)
to enlarge the drainage canal. ,
relieving pressure inside the eye.
7. Diode laser cycloablation :-
When trabeculectomy or
When trabeculectomy or
glaucoma drainage tube has failed
then they may consider
cycloablation.it involves permanent
destruction of the ciliary body. ( which
produces the aqueous fluid ) it is
usually the last line of treatment for
uncontrolled glaucoma.

41. NURSING MANAGEMENT
1) Pre-operative care
2) Post-operative care
Administered Opioids,antiemetics, antibiotics as
directed.
Reassure patient that,with reduction in IOP,pain
Reassure patient that,with reduction in IOP,pain
& other sign & symptoms should subside.
Provide reassurance & calm presence to reduce
anxiety & fear.
Provide knowledge regarding glaucoma,their
sign & symptoms & Management.

42. COMPLICATION
• GLAUCOMA SURGERIES INCLUDE
• CHOROIDAL DETACHMENT;
• OCULAR DECOMPRESSION RETINOPATHY
• HAEMORRHAGIC CHOROIDAL DETACHMENT
• HAEMORRHAGIC CHOROIDAL DETACHMENT
• HYPOTONY MACULOPATHY
• VITREOUS HAEMORRHAGE
• RETINAL DETACHMENT.

43. • Choroidal detachments occur when there is
an accumulation of fluid or blood in the
suprachoroidal space, a potential space situated
between the choroid and the sclera.
• Ocular decompression retinopathy (ODR) is an
rare postoperative complication that occurs as a
rare postoperative complication that occurs as a
result of rapid intraocular pressure lowering
interventions. The clinical appearance is
characterized by multiple
round intraretinal hemorrhages, some with white
centers,

44. • Hemorrhagic choroidal detachment is a
hemorrhage in the suprachoroidal space or
within the choroid caused by the rupture of
choroidal vessels.
• Hypotony maculopathy is characterized by a
• Hypotony maculopathy is characterized by a
low IOP associated with fundus abnormalities,
including chorioretinal folds, optic nerve head
edema

45. • Vitreous hemorrhage is seen as blood floating in
vitreous, occluding the view of retina variably.
• Retinal detachment describes an emergency
situation in which a thin layer of tissue (the
situation in which a thin layer of tissue (the
retina) at the back of the eye pulls away from its
normal position. Retinal detachment separates
the retinal cells from the layer of blood vessels
that provides oxygen and nourishment to the
eye.