INTRODUCTION ETIOLOGY RISK FACTORS PATHOPHYSIOLOGY CLASSIFICATION CLINICAL FEATURES DIAGNOSTIC MEASURES MANAGEMENT Medical Surgical Nursing CONCLUSION BIBLIOGRAPHY POST TEST

1. COMMON GERIATRIC CONDITION & ITS
MANAGEMENT
PRESENTATOR
• Ms. Sakun Rasaily
• PAEDIATRIC WARD
• BPKIHS
• sakunrasaily@gmail.com
GLAUCOMA.

2. PRESENTATUON OUTLINES
INTRODUCTION
ETIOLOGY
RISK FACTORS
PATHOPHYSIOLOGY
CLASSIFICATION
CLINICAL FEATURES
DIAGNOSTIC MEASURES
MANAGEMENT
• Medical
• Surgical
• Nursing
CONCLUSION
BIBLIOGRAPHY
POST TEST

3. INTRODUCTION
The term Glaucoma is a term used to refer
group of ocular condition characterized by the
optic nerve damage. Glaucoma occurs as a
result of increased intraocular pressure (IOP)
caused by a malformation or malfunction of
the eyes drainage system. Normal IOP is 19 –
21 inches of mercury. The increased pressure
causes compression of the retina and the optic
nerve, and causes progressive , permanent loss
of eyesight if left untreated.

4. DEFINITION
 Glaucoma is a group of disorder
characterized by an abnormally high
intraocular pressure , optic nerve dystrophy,
and peripheral filed loss.
(BRUNNER)
 Glaucoma is a symptomatic condition of
the eye where the intraocular pressure is
more than normal.
(L.P AGARWAL)

5. INCIDENCE
 Globally 60 to 67 million.
 More common in peoples older than 40
years.

6. ETIOLOGY
Increased intraocular pressure.( more than
24 mmhg)
Optic nerve dystrophy.
Other associates disease condition.
 Poor or reduced blood flow to the optic nerve.
 Dilating eye drops.
 Elevated blood pressure.

7. RISK FACTORS
 Genetic Factors :Family history
: above 40
 Aging
 Eye trauma
 Hypertension
 Severe Myopia
 Ocular surgery
 Diabetics mellitus

8. • Emotional stress.
• Caffeine consumption .(increasesIOP)
• Ethnicity ( More common in Black
people compared to white people)
• Prolonged use of corticosteroid

9. PATHOPHYSIOLOGY
Excess production of
aqueous humor
Decreased outflow of
aqueous humor
Sed IOP

10. .
. Ischemia of Nerve.
Damage to optic nerve
LOSS OF VISION

11. CLASSIFICATION
GLAUCOMA
 Primary Glaucoma
 Secondary Glaucoma
CONGENTIAL ACQUIRED
 True congenital.
 Infantile
 Juvenile

12. CONGENTIAL GLUCOMA
 Rare disease.
 Occurs when a congenital defect in the angle
of the anterior chamber obstructs the
outflow of aqueous humor.
 If remains untreated causes damage to optic
nerve damage and blindness.
1. True Congenital Glaucoma
 occur when IOP increases during
intrauterine period.

13. • INFANTILE GLAUCOMA.
occurs during third birthday
occurs about 10% of cases.
• JUVENILE GLAUCOMA
Occurs during 3 to 16 years of life.
occurs in about 10 % of casas

14. Clinical features of congenital
glaucoma
Lacrimation
Photophobia
Corneal oedema
Raised IOP
Eyes Become MYOPIC
Corneal diameter more than
13mmhg

15. ACQUIRED GLAUCOMA
• PRIMARY GLUCOMA.
 Primary Open angle glaucoma.
 Primary angle closure Glaucoma
 Chronic angle closure glaucoma.
• SECONDARY GLAUCOMA
 Lens induced glaucoma
 Glaucoma due to uveitis
 Neurovascular Glaucoma
 Glaucoma associated with intraocular
tumor
 Steroid induced glaucoma

16. • PRIMARY GLAUCOMA.
PRIMARY GLAUCOMA IS A PROGRESSIVE CONDITION
and is most common cause of
irreversible
blindness across world wide.
A .Primary Open Angle Glaucoma
 Also Called as open angle Glaucoma or
chronic simple Glaucoma or simple
complex Glaucoma.
 Results from the overproduction ofaqueous
humour through trabecularMesh work
results in increased IOP and Damage to
optic nerve, results in loss of vision.

17. .
• The clinical features of Primary Open angle
glaucoma includes.
 Mild ache in the eyes
 Headache
 Increased IOP ( more than24
mmhg)
 Loss of Peripheral vision
 Reduced visual acquity at night.
 Corneal edema
 Visual field deficit.

18. B. PRIMARY ANGLE CLOSURE GLAUCOMA
 It is also called as Primary closed angle
glaucoma, Narrow angle glaucoma, Pupil
block glaucomaand acute congestiveglaucoma.
 Onset : rapid, ophthalmic emergency. Unless
treated promptly the causes blindness in 3 or
5days.
 This is due to the abnormality of structure infront
of the eyes. This result from the obstruction to the
outflow of aqueous humor.

19. CLINICAL FEATURES OF PRIMARY ANGLE CLOSURE
GLAUCOMA
 Pain and redness in eyes
 Increased IOP
 Blurred vision
 Headache
 Nausea
 Vomiting
 Oedematous cornea
 Decreased visual acuity
 Moderate Pupillary
dilation.

20. C. CHRONIC ANGLE CLOSURE GLAUCOMA
 Chronic angle closure Glaucoma may
develop as the sequelae to an attack of
acute angle glaucoma.
 Clinical features include
IncreasedIOP. visual
fielddefect.
Decreasedvisual
acquity.

21. 2. SECONDARY GLAUCOMA
 Secondary glaucoma occurs as a result of
either diseases within the eyes such as
uveitis, Inflammation , Trauma, intra ocular
haemorrhage, previous surgeries, diabetics
and steroid medication etc
 The major types include

22. TYPES
o LENSINDUCEDGLAUCOMA
o GLAUCOMADUETOUVEITIS
o NEUROVASULARGLAUCOMA
o GLAUCOMAASSOCIATEDWITH INTRA
o OCULARTUMOR.
o STEROIDINDUCEDGLAUCOMA

23. .
1. LENS INDUCED GLAUCOMA
 It occur due to trabecular blockage.
 it occur due to closing of trabeculae by
inflammatory material.
• 2. GLAUCOMA DUE TO UVEITIS
 IOP is raised due to clogging by inflammatory
material & associated trabeculitis.

24. 3. NEURO VASCULAR GLAUCOMA
 Uncommon type of glaucoma
 Difficult to treat
 Caused by proliferative diabetic retinopathy.
 Individual with poor blood flow to the eyes are highly
at risk for this condition.
4. GLAUCOMA ASSOCIATED WITH INTRAOCULAR
TOMOR.
 Intraocular tumor such as retinoblastoma may rise IOP.

25. 5. STEROID INDUCED GLAUCOMA
 Developed due to sensitivity to steroid.
 Sudden rise in IOP may occur, this can
be prevented by judicious use of
steroid.

26. DIAGNOSTIC MEASURES
 History collection
 Tonometry ( to measure IOP)
 Ophthalmoscopy ( Toshow the cupping of
the optic disc )
 Gonioscopy(To determine the angle of the
eyes anterior chamber)
 Perimetry or visual field test.( Todetect loss
of peripheral vision)

27. .
 Slit Lamp Examination.
 Pachymetry
 Nerve fiber analysis ( to asses the thickness
of nerve fiber layer)

28. COMPLICATIONS
 Complete loss of vision.
 Choroidal detachment.
 Retinal detachment.
 Anterior Segment necrosis.
 Chronic pain.
 Psychologocal altered.
 Low self steam.

29. MANAGEMENT
• GoalofManagement-
• ToreduceIOP.
 Topreventthedamageofopticnerve.
 Topreventfromworse.
 Toprovidecomforttothepatient.
 Managementmeasuresmainlyinclude
 MedicalManagement
Surgicalmanagement
 NursingManagement

30. MEDICAL MANAGEMENT
1. Beta adrenergic blockers :
• decreases aqueous humor production , eg
Timolol, betaxolol.
2 Cholinergic ( Miotics) :
• Reduces IOP by facilitating the outflow
of aqueous humor.
eg Pilocarpine, Carbacol.
3 Carbonic anhydrase inhibitor :
• Decreases the formation of aqueous humor.

31. 4 Prostaglandin Analogs.
:
Reduces IOP by increasing uveoscleral
Flow.
5 Osmotic Agents :
Iv mannitol 20% or oral glycerine 50% is
used to reduce IOP by creating an osmotic
pressure between blood and intraocular
fluid.

32. SURGICAL MANAGEMENT
1 Argon Laser Trabeculoplasty :
 Used to treat open angle glaucoma.
 Thermal Argon laser burns are applied to
the inner surface of trabecular Meshwork to
open intra trabecular spaces , thus reduces
outflow of aqueous humor and decreases
IOP.

33. 2 Laser Iridotomy : In this surgical procedure, an
opening is made by the laser beam in the iris
to eliminate pupillary block.
 Relive the pressure & preserve the vision
by promoting outflow of the aqueous
humor.
3 Cyclocryotherapy
Application of a freezing probe to the sclera
over the Cillary body that destroy some of the
cillary processes , results in the reduction of
the amount of the aqueous humor

34. .
4 Cyclodialysis
Through a small incision in the sclera a
spatula type instrument is passed into the
anterior chamber, creating an opening in the
angle.
5 Filtering Procedure
For Chronic Glaucoma filtering procedure
are used to create an opening or fistula in the
trabecular meshwork to drain aqueous humor.
This allow the aqueous humor to flow.

35. 6 Trabeculotomy
 In this procedure a par
.
tial thickness
incision is made in the sclera.
 Section of sclera is removed to produce
an opening for outflow of aqueous
humor.
7 Drainage implants and shunts
 Used to Shunt the aqueous humor in
the Conjunctival space.
 Implants and shunts are the open tubes
implanted in the anterior chamber
through sclerotomy

36. NURSING MANAGEMENT
ASSESSMENT
 History collection ( positive family
history)
 Risk factors such as tumor of eyes.
 Intraocular haemorrhage.
 Inflammatory intraocular uveitis.
 Eyes contusion from trauma.

37. General Physical exam.
ination
 Assess for Sudden severe pain in eyes,
blurred vision etc.
 Check for diagnostic Measures.
 Assess the patient Understanding
and emotional response to the
condition.

38. NURSING DIAGNOSIS
 Acute pain related to increased IOP.
 Self care deficit related to loss of vision.
 Fear and anxiety related to Pain and
potential loss of vision.
 Risk for further injury related to progressive
increase iop.

39. NURSING INTERVENTION
 Assess the IOP.
 Elevate the head end of the bed at 30
degree angle. ( Patient should be placed in
un operated side)
 Instruct the patient not to touch the eyes .
 Encourage the patient to wear eye shield. (
To prevent infection).
 Administer medications as prescribed.

41. CONCLUSION
 Glaucoma is a condition that causes damage
to the eyes optic nerve& gets worse over the
time. Without treatment the glaucoma can
cause permanentblindness within few years.
So the treatment should be given at right
time to prevent complications.

42. BIBIOGRAPHY
 K Khurana, Textbook of Ophthalmic Nursing, CBS
Publishers, Banglore,6th edition 2008, PG NO 141 –
153.
 Black.M.Joyce.Text book of Medical Surgical
Nsg.Elsevier Publication.8 th edition. Pg no 567 – 568.
 Chintamani, Lewis, Text book of Medical surgical
Nursing, Elsevier Publication 13 th edition. volume
1. 2011.pg no 1723-1725.
 Medscap.

43. POST TEST
1 What do you understand about glaucoma ?
2 What are the risk factors of glaucoma ?
3 What do you mean bt IOP ?
4 State the classification of glaucoma ?
5 State diagnostic test to find out the glaucoma ?
6 Any three clinical picture of glaucoma ?

44. .