Glaucoma: Types, and Risk Factors

• Glaucoma is a group of eye diseases damaging the optic nerve, frequently from abnormally high eye pressure.
• Glaucoma is a primary cause of irreversible blindness.
• Early glaucoma detection and treatment aids in preventing vision loss.

Types of Glaucoma

• Open-angle glaucoma, the most common type, features a wide, open angle between the iris and cornea.
• Angle-closure glaucoma (closed-angle or narrow-angle) occurs when the angle between the iris and cornea is narrow or closed.
• Normal-tension glaucoma involves optic nerve damage despite normal eye pressure.
• Congenital glaucoma, a rare condition occurring at birth.
• Secondary glaucoma stems from other medical issues or medications.

Risk Factors

• Elevated intraocular pressure (IOP) is a major risk factor.
• A family history of glaucoma raises the risk.
• Age over 60 increases the risk, especially for open-angle glaucoma.
• African Americans and Hispanics face a higher risk.
• Diabetes, hypertension, and heart disease can elevate the risk.
• Myopia (nearsightedness) poses a risk.
• Extended use of corticosteroid medications can heighten risk.

Signs and Symptoms

• Open-angle glaucoma often lacks early symptoms.
• Gradual peripheral vision loss is a typical symptom.
• Advanced glaucoma leads to tunnel vision.
• Angle-closure glaucoma can manifest as sudden eye pain, blurred vision, halos around lights, headache, nausea, and vomiting.
• Symptoms of angle-closure glaucoma require immediate medical care.

Diagnosis

• Tonometry measures intraocular pressure (IOP).
• Normal IOP ranges from 10-21 mmHg, but glaucoma is possible with normal IOP.
• Gonioscopy examines the angle between the iris and cornea.
• Ophthalmoscopy assesses the optic nerve for damage.
• Visual field testing maps the scope of peripheral vision.
• Optical coherence tomography (OCT) scans the optic nerve and retina.

Treatment

• Medications, laser therapy, and surgery lower IOP and avert further optic nerve damage.
• Treatment seeks to slow glaucoma's progression, as vision loss is irreversible.

Medications

• Prostaglandin analogs enhance fluid outflow from the eye, including latanoprost, bimatoprost, and travoprost.
• Beta-blockers reduce fluid production in the eye, such as timolol and betaxolol.
• Alpha-adrenergic agonists lower fluid production and increase outflow, like brimonidine and apraclonidine.
• Carbonic anhydrase inhibitors curtail fluid production, including dorzolamide, brinzolamide, and acetazolamide.
• Miotic or cholinergic agents boost fluid outflow, exemplified by pilocarpine.
• Medications are often combined to reach target IOP.

Laser Therapy

• Laser trabeculoplasty improves fluid drainage in open-angle glaucoma.
• Laser iridotomy creates an iris hole for better fluid flow in angle-closure glaucoma.
• Cyclophotocoagulation reduces fluid production in the eye.

Surgery

• Trabeculectomy forms a new drainage route for fluid to exit the eye.
• Glaucoma drainage implants (tubes) divert fluid to an external reservoir.
• Minimally invasive glaucoma surgery (MIGS) is less invasive with quicker recovery.

Nursing Interventions

• Administer prescribed eye drops, ensuring proper technique and adherence.
• Teach patients about the importance of regular eye exams and IOP monitoring.
• Inform patients about potential medication side effects, and to report any adverse reactions.
• Offer emotional support and resources for patients and families coping with vision loss.
• Educate patients on strategies for maximizing remaining vision and adapting to visual impairment.

Patient Education

• Explain the necessity of sticking to medication regimens.
• Demonstrate the correct eye drop instillation, including punctal occlusion to cut down on systemic absorption.
• Advise against activities increasing IOP, such as heavy lifting or straining.
• Encourage regular exercise and a balanced diet.
• Stress the importance of follow-up appointments with the ophthalmologist.
• Inform patients about visual rehabilitation resources and support groups.

NCLEX Considerations

• Focus on medication administration, side effects, and patient education.
• Prioritize interventions that prevent further vision loss and boost safety.
• Understand the distinctions between open-angle and angle-closure glaucoma.
• Know that acute angle-closure glaucoma symptoms are a medical emergency.
• Highlight the importance of routine eye exams for early detection and prevention.

Wolters Kluwer Type Questions

• Questions often involve prioritization, delegation, and critical thinking in glaucoma management.
• Expect scenarios concerning medication administration, patient education, and visual change assessment.
• Questions may assess understanding of different glaucoma types, risk factors, and treatments.
• Be ready for questions on the nursing role in aiding glaucoma patients and preventing complications.
• Questions may require analyzing lab values (e.g., IOP) and diagnostic results (e.g., visual field testing).