Glaucoma is a disease of the major nerve of vision, called the optic nerve. The optic nerve receives light-generated nerve impulses from the retina and transmits these to the brain, where we recognize those electrical signals as vision. Glaucoma is characterized by a particular pattern of progressive damage to the optic nerve that generally begins with a subtle loss of side vision (peripheral vision). If glaucoma is not diagnosed and treated, it can progress to loss of central vision and blindness.
Glaucoma is usually, but not always, associated with elevated pressure in the eye (intraocular pressure). Generally, it is this elevated eye pressure that leads to damage of the eye (optic) nerve. In some cases, glaucoma may occur in the presence of normal eye pressure. This form of glaucoma is believed to be caused by poor regulation of blood flow to the optic nerve.
Symptoms and Signs
Patients with open-angle glaucoma and chronic angle-closure glaucoma in general have no symptoms early in the course of the disease. Visual field loss (side vision loss) is not a symptom until late in the course of the disease. Rarely patients with fluctuating levels of intra-ocular pressure may have haziness of vision and see haloes around lights, especially in the morning.
On the other hand, the symptoms of acute angle-closure are often extremely dramatic with the rapid onset of severe eye pain, headache, nausea and vomiting, and visual blurring. Occasionally, the nausea and vomiting exceed the ocular symptoms to the extent that an ocular cause is not contemplated.
The eyes of patients with open-angle glaucoma or chronic angle-closure glaucoma may appear normal in the mirror or to family or friends. Some patients get slightly red eyes from the chronic use of eyedrops. The ophthalmologist, on examining the patient, may find elevated intraocular pressure, optic-nerve abnormalities, or visual field loss in addition to other less common signs.
The eyes of patients with acute angle-closure glaucoma will appear red, and the pupil of the eye may be large and nonreactive to light. The cornea may appear cloudy to the naked eye. The ophthalmologist will typically find decreased visual acuity, corneal swelling, highly elevated intraocular pressure, and a closed drainage angle.
Source : www.medicinenet.com
Nursing Care Plan for Glaucoma
Nursing Assessment for Glaucoma
- History or presence of risk factors :
- Positive family history (believed to be associated with primary open angle glaucoma).
- Tumors of the eye
- Hemorrhage intraocular
- Inflammatory intraocular uveiti)
- Eye contusion from trauma.
- Physical examination based on those in the general assessment of the eye may indicate:
For primary open angle
Reported a loss of peripheral vision slow (see tunnel)
For primary angle closure :
- Incidence of sudden severe pain in the eye is often accompanied by headache, nausea and vomiting.
- Complaints halo light, blurred vision, and decreased light perception.
- The pupils are being fixed with redness due to inflammation of the sclera and cornea looks cloudy.
- Diagnostic Examination
- Tonometri used to measure intra-ocular pressure. Glaucoma is suspected when IOP greater than 22 mmHg.
- Gonioskopi possible to see directly the anterior chamber angle glaucoma to distinguish between closed and open-angle glaucoma.
- Optalmoskopi allow inspectors to see directly optic disc and internal eye structure.
- Assess the patient's understanding about the condition and emotional response to the condition and plan of action.
Nursing Diagnosis and Nursing Interventions for Glaucoma
Pain related to spasm, intra-ocular pressure, glaucoma acute.
Which is characterized by :
- patients express pain in the eye,
- protect the side of the pain patients,
- frowned and whimpered.
reduction of discomfort, said pain is gone / reduced, relaxed facial expression, no moaning.
- Monitor blood pressure, pulse, and respiration every 4 hours.
Monitor the degree of eye pain every 30 minutes during the acute phase.
Monitor input and output every 8 hours while receiving intravenous osmotic agent.
Monitor visual acuity at any time before hatching ophthalmic agents.
- Give appropriate instructions optalmic agent for glaucoma. Inform your doctor if :
- urinary output of less than 240 ml / hour
- No loss of pain in the eye within 30 minutes of drug therapy
- Decrease in constant visual acuity.
- Prepare patients for surgery
- Maintain bed rest in semi-Fowler position. Prevent increase in IOP :
- Instruct to avoid coughing, sneezing, straining, or placing the head below the pelvic
- Provide quiet environment and avoid light.
- Give anlgetic prescription and evaluation of its effectiveness.