Glaucoma is a group of eye disorders characterized by abnormally high intraocular pressure that can damage the optic nerve and result in vision loss. The document defines glaucoma and identifies primary open-angle glaucoma and primary angle-closure glaucoma as the two most common types. Risk factors include aging, genetics, eye injuries or surgeries, and certain medical conditions. Treatment involves medications or surgery to reduce pressure in the eye in order to prevent further vision loss from optic nerve damage.

1. GLAUCOMA
Shyam Bhatewara
Lecturer
Index nursing college

2. Definition
Glaucoma is a group of disorder characterized by an
abnormally increase in intra ocular pressure (more than
21mm Hg), optic nerve dystrophy & peripheral visual
field loss
The condition damages the optic nerve and can result in
blindness.

3. Risk factors
Genetic
Aging
Hypertension
Severe myopia
Eye trauma
Ocular surgery
Diabetes mellitus
Prolonged use of local or
systemic corticosteroid
Extreme dilation of the
pupil
Emotional excitement
Migraine headache

4. Classification
Congenital glaucoma
 True Congenital glaucoma
 Infantile glaucoma
 Juvenile glaucoma
Acquired glaucoma
A.Primary glaucoma
 Primary open angle glaucoma
 Primary angle closure glaucoma
B. Secondary glaucoma

5. Primary open angle glaucoma
Open angle is the most common type of glaucoma . It is
usually bilateral, with insidious onset and slowly
progressive course without discomfort or pain.
It is result from overproduction or obstruction of the out
flow of aqueous humor through the trabecular meshwork
& causing increased intraocular pressure

6. Clinical manifestation
Mild aching in the eyes
Mild headache
Increased IOP that is > 21 mm hg
Loss of peripheral vision
Reduce visual acuity, specially at night
Failure to detect color changes

7. Primary angle closure glaucoma
It is also known as primary closed angle glaucoma,
narrow angle glaucoma, pupil block glaucoma,
acute congestive glaucoma.
It occur because of an abnormally of structure in
the front of eye. this results from obstruction to the
outflow of aqueous humor.
Obstruction caused by anatomically narrow angle
between anterior iris and posterior corneal surface,
shallow anterior chamber, a thickened iris that
cause angle closure.

8. Clinical manifestation
Pain & redness in eyes
Increased IOP between 40-
70 mm Hg
Blurred vision
Optic disk is hyperemic
Halo may be seen
around bright light
Headache
Nausea vomiting cornea
edematous
Decrease visual acuity
Photophobia
Moderate pupillary dilation

9. Diagnostic evaluation
Detailed history collection
Physical examination
Tonometry
opthalmoscopy
Slit lamp examination

10. Management
Beta adrenergic blockers- Timolol, Betaxolol are used to decrease
aqueous humor production
Cholinergic (miotics) – pilocarpine, carbacol are used to reduce IOP by
facilitating the out flow of aqueous humor.
Carbonic anhydrase inhibitors - dorzolamide, methazolamide, or
acetazolamide to decrease the formation & secretion of aqueous humor.
Adrenergic agonist – Epinephrine to reduce IOP by improving aqueous
humor flow
Prostaglandin analogus – latanoprost to reduce IOP by increase
uveoscleral outflow
Osmotic pressure - IV mannitol

11. Surgical management
Argon Laser Trabeculoplasty – it may be used to treat
open angle glaucoma. In laser trabeculoplasty, thermal
argon laser burns are applied to the inner surface of the
trabecular meshwork to open the intra trabecular spaces &
widen the canal of schlemm, thereby increasing the out
flow of aqueous humor & decrease IOP.
Laser Iridotomy – an opening is made by the laser beam
in the iris to eliminate the pupilary block. It relieves
pressure & preserves vision by promoting outflow.

12. Cyclocryotherapy – Application of freezing probe to the
sclera over the cilliary body that destroy some of the
ciliary processes, results in the reduction production of
aqueous humor.
Cyclodialisis - Through small incision in the sclera, a
spatula type instrument is passed into the anterior
chamber, creating an opening in the angle.

13. Filtering procedure – for chronic glaucoma filtering
procedures are used to create opening or fistula in the
trabecular meshwork to drain aqueous humor from the
anterioir chamber to the subconjunctival space into bleb.
Trabeculotomy
Sclerotomy
Drainage implant or shunt

14. Instruct the client on the importance of medications to
constrict the pupils (miotics), to decrease the production of
aqueous humor (carbonic anhydrase inhibitors), and to
decrease the production of aqueous humor and IOP (beta
blockers).
Instruct the client about the need for lifelong medication
use, to wear a Medic Alert bracelet, to avoid
anticholinergic medications to prevent increased IOP, and
to contact the health care provider (HCP) before taking
medications, including over-the counter medications.

15. Instruct the client to report eye pain, halos around the
eyes, and changes in vision to the HCP.
Instruct the client that when maximal medical therapy has
failed to halt the progression of visual field loss and optic
nerve damage, surgery will be recommended.
Prepare the client for trabeculectomy as prescribed, which
allows drainage of aqueous humor into the conjunctival
spaces by the creation of an opening.