Alterations of Eyes: Glaucoma

Glaucoma is a condition in which an obstruction of outflow occurs within the trabecular meshwork and the canal of Schelmn leading to increased pressure within the eyeball.

Risk factors:

  1. Being at the age of 40
  2. Diabetes mellitus
  3. Hypertension
  4. Heredity
  5. Previous ocular injury

Two types of Glaucoma:

  1. Chronic glaucoma – open angle glaucoma; This happens bilaterally and destroys optic nerve function causing blindness.
  2. Acute glaucoma – closed angle glaucoma; This is sudden, complete, unilateral closure with dilation stimulated by dark environment, emotional stress or mydriatic drugs. This is a medical emergency and delay in immediate response may lead to blindness within days after the onset.

Diagnostic Tests:

  1. Visual Acuity – The result is reduced visual acuity.
  2. Tonometry – A reading of 24 to 32 mmHg suggests glaucoma
  3. Opthalmoscopic Exam – shows the narrowing of small vessels
  4. Perimetry – Shows defects in visual fields

Medical Management:

  1. Administration of medications:
    • Miotics (Pilocarpine) – constricts the pupil and draws the smooth muscle of the iris away from the canal of Schlemn to permit aquoues humor to drain out
    • Carbonic anhydrase inhibitors (Diamox) – restricts the action of enzyme necessary to produce aqueous humor
    • Anticholinesterase (Humersol) – helps in outflow of aqueous humor
    • Sympathomimetic drugs (Epinephrine) – reduces the rate of production of aqueous humor
    • Hyperosmotic agents – increases blood osmolarity
    • Beta adrenergic drugs (Timolol maleate) – reduce production of aqueous humor without changing pupil
  2. May perform surgical treatment:
    • Peripheral iridectomy
    • Irideclesis
    • Cyclodiathermy or cyclotherapy
    • Trabeluectomy

Nursing Management:

  1. Emphasize the importance of refraining from activities that increases intraocular pressure such as stooping, heavy lifting or pushing.
  2. Avoid emotional flare ups.
  3. Encourage exercise in moderation only.
  4. Maintain accurate intake and output.
  5. Use eyes in moderation when reading or watching TV.


Photo credits:

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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