Glaucoma Handout PDF

8/25/2024 Eye Conditions: Glaucoma NU RS641 F NP1 Pre pared and Presente d by Lori -Jeanne West ©Lori-Jeanne West, 2024 Rep roduction of th is mater ia l is proh ibited w ith out the auth or’s co nsen...

8/25/2024 Eye Conditions: Glaucoma NU RS641 F NP1 Pre pared and Presente d by Lori -Jeanne West ©Lori-Jeanne West, 2024 Rep roduction of th is mater ia l is proh ibited w ith out the auth or’s co nsen t. Postin g or sharin g of these mate rials w itho ut the autho r’s con sen t is a copyright vio lation. Overview and Presentation Glaucoma is charac terized by progressive damage to the optic nerve Clas sic triad: Increased IOP, optic nerve atrophy , visual field loss Open angle glaucoma: most c ommon type, chronic, progres sive, caus es optic nerve damage and ass ociated visual field loss , good prognosis if treated early Angle closure glauc oma: acute episodes of significant eye pain, redness, acute vision loss, if left untreated can cause permanent blindness, may have s ubac ute or chronic components Primary vs Secondary: ocular condition vs sy stemic process 1  8/25/2024 Overview and Presentation Prevalence of glaucoma 4-5 times higher among blac k people than white people, 15 times more lik ely to cause to c ause blindness in black patients than white patients Primary open angle glaucoma is most prevalent form of glaucoma and accounts for 90-95% of all cases Angle closure glauc oma affects approx. 0.1% of population, aged 50-70 years, more prevalent in people of Asian and native Alaskan descent Risk Factors: inc reased IOP, family history, older age, African desc ent, decreas ed corneal thickness and inc reased cup to disk ratio, medications use (corticosteroids, v is coelastic agents), uv eitis, trauma, intraocular tumors Physical Exam Eye Exam: vision testing, pupillary size, light reactivity, redness, pain Open angle: gradual onset, slow, painless, bilateral peripheral vision loss and poor night vision, later stages may see halo around lights and further visual field loss Acute angle closure: rapid onset, unilateral pain and pressure, blurred vision, halos around lights, photophobia, loss of peripheral vision loss AND followed by central vision loss, may have headache and nausea/vomiting o Chronic angle closure has in sidious onset similar to o pen angle, pat ients ma y re port vague eye discomfort and intermit tent blurred vision Diagnostics Patients older than 40 with family history of glaucoma need eye exams every 1-2 years No single test: finding of characteristic degenerative changes in optic nerve and visual field defects Refer to Ophthalmologist: IOP testing (tonometery), combination of tests to examine the optic nerve, visual field defects, and corneal thickness o Increased IOP alone does not diagnose glaucoma 2  8/25/2024 Differentials Conjunctivitis Uveitis Medication use (corticosteroids, amphetamines, chlorpromazine) that increases IOP Treatment Refer to ophthalmologist Nerve damage is irreversible: goal of treatment- prevent progression Adequate lowering of IOP, goal of 30% reduction in IOP Medication eye drops or surgical intervention: Du np hy tab le 20.1, p ag e 29 4 – First line eye drops are prostaglandin analogs: 1x/day dosing, efficacy, decreased systemic absorption – Beta block ers and alpha-agonists are alternative options – Surgical laser therapy (LTP), may only last a few years – Acute angle closure: Diamox, IV mannitol, topical miotic, followed by laser therapy, bedrest during acute attack Patient Education Lifelong follow up with ophthalmologist Educate on signs/symptoms of worsening condition Emphasize medication compliance, potential adverse effects of glaucoma meds, contraindications such as use of systemic corticosteroids Teach how to instill eye drops 3  8/25/2024 References Buttaro, T.M., Polgar-Bailey, P., S and berg -Cook, J., & Trybulski, J. (202 1). Primar y care: Interpro fess ion al collabor ative pr actice (6th ed.). Elsevier. Du nphy, L. M., Win land-Brow n, J. E., Porter, B. O., & Thomas, D. J. ( 2022). Primar y care: The ar t and science of advanced pr actice nurs in g and inter professional approach (6th ed.). F. A. Davis Company. 4