This study guide is about glaucoma, diagnosis of glaucoma, treatment for glaucoma, and 3 nursing care plans for glaucoma. Use it to create educational nursing care plans for glaucoma.
What is Glaucoma?
Glaucoma or increased intraocular pressure (IOP) is a group of eye conditions caused by abnormally high eye pressure eventually damaging the nerve that is responsible for good vision called the optic nerve. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness. Glaucoma tends to be inherited and may not show up until later in life.
There are two primary categories of glaucoma: (1) open-angle and (2) closed-angle (or narrow-angle). Chronic open-angle glaucoma is the most common type, accounting for 90% of all glaucoma cases. It develops slowly, may be associated with diabetes and myopia, and may develop in both eyes simultaneously. Chronic glaucoma has no early warning signs, and the loss of peripheral vision occurs so gradually that substantial optic nerve damage can occur before glaucoma is detected.
Narrow-angle, or angle-closure, glaucoma is the less common form and may be associated with eye trauma, various inflammatory processes, and pupillary dilation after the instillation of mydriatic drops. Acute angle-closure glaucoma is manifested by sudden excruciating pain in or around the eye, blurred vision, and ocular redness. This condition constitutes a medical emergency because blindness may suddenly ensue.
What are the Signs and Symptoms of Glaucoma?
Signs and symptoms of glaucoma depend on the type and stage of the condition:
- Open-angle glaucoma
- patchy blind spots on the peripheral and central visual fields on both eyes
- tunnel vision (advanced stage)
- Acute angle-closure glaucoma
Other Signs and Symptoms Include:
- Severe headache
- Eye pain
- Nausea and vomiting
- Blurred vision
- Halos around lights
- Eye redness
What are the Causes and Risk Factors of Glaucoma?
Glaucoma is the result of optic nerve deterioration causing blind spots in the visual field. This is commonly related to increased intraocular pressure caused by the accumulation of aqueous humour flowing inside the eye. It normally drains through a trabecular meshwork where the iris and cornea meet but, when it is overproduced or if the drain malfunctions, the pressure also increases. Glaucoma is believed to be a genetic condition and scientists have discovered that some people have a specific gene related to increased intraocular pressure. There are five types of glaucoma: Open-angle glaucoma, Angle-closure glaucoma, Normal-tension glaucoma, Glaucoma in children, Pigmentary Glaucoma.
1. Open-angle glaucoma. It is the most common form of the disease. The drainage angle formed by the cornea and the iris stays open but the trabecular meshwork is partially blocked. This causes gradual increase in eye pressure and is barely noticeable, even until the person is actually aware of the problem.
2. Angle-closure glaucoma. This occurs when the iris bulges forward to block the drainage angle, thus preventing eye fluid circulation and increasing eye pressure. Some people already have narrow drainage angles, putting them at higher risk for this type of glaucoma. This may happen gradually or suddenly and is considered as a medical emergency.
3. Normal-tension glaucoma. In this type of glaucoma, the optic nerve is damaged despite having normal eye pressure. The exact cause is unknown. The person may have a sensitive optic nerve or have less blood supply to the optic nerve. This may be caused by atherosclerosis or other conditions that impede circulation.
4. Congenital glaucoma. It is also possible for children and infants to have glaucoma either from birth or in the first few years of life and can be caused by drainage blockage or some underlying medical condition.
5. Pigmentary glaucoma. It is characterized by the build-up of pigment granules from the iris into the drainage channels, blocking fluid from exiting the eye. Activities such as jogging increase the production of these granules and cause intermittent increase in eye pressure.
The risk factors for developing glaucoma include:
- High internal eye pressure
- Age 60 and over
- Race: Black, Asian, Hispanic
- Family history of glaucoma
- Medical conditions such as diabetes, heart disease, high blood pressure, and sickle cell anemia
- Thin-centred corneas
- Extreme near-sightedness or far-sightedness
- Previous eye injury or surgery
- Long-term corticosteroid use (could be in eye drop form)
Diagnosis of Glaucoma
How do you Diagnose Glaucoma?
The doctor will review the patient’s medical history and conduct a series of tests including:
- Tonometry – to measure intraocular pressure
- Dilated eye exam and imaging tests – to check for optic nerve damage
- Eye chart test – to check for areas of visual loss
- Pachymetry – to measure corneal thickness
- Gonioscopy – to inspect the drainage angle
Treatment for Glaucoma
What are the Available Treatment Options for Glaucoma?
- Eye drops. The eye drops help improve fluid drainage or decrease amount of fluid produced by the eye. Depending on the target eye pressure, the patient may be prescribed one or more of the following:
- Prostaglandins – increase outflow of fluid in the eyes; side effects include mild eye reddening and stinging, iris darkening, eyelashes or eyelid skin darkening, and blurred vision
- Beta blockers – reduce eye fluid production; side effects include difficulty of breathing, hypotension, bradycardia, impotence, and fatigue
- Alpha adrenergic agonists – increase outflow of fluid in the eye and reduce aqueous humour production; side effects include irregular heart rate, hypertension, fatigue, red, itchy or swollen eyes, and dry mouth
- Carbonic anhydrase inhibitors – reduce fluid production; side effects include metallic taste, urinary frequency, and tingling in fingers and toes
- Rho kinase inhibitors –reduce fluid build-up; side effects include eye redness, or eye discomfort
- Mitotic or cholinergic agents -increase fluid outflow; side effects include headache, eye ache, smaller pupils, blurred vision, and near-sightedness
Oral medications. If eye drops are insufficient, oral medications like a carbonic anhydrase inhibitor will be prescribed.
Surgery. Surgical interventions to treat glaucoma include:
Minimally invasive glaucoma surgery
If left untreated, glaucoma will eventually lead to blindness. However, despite treatment, about 15% of glaucoma patients are at risk for developing blindness in 20 years. If a person experiences any of the above symptoms of acute angle-closure glaucoma, it is best to proceed to the local hospital’s emergency department or seek an ophthalmologist as soon as possible.
3 Nursing Care Plans for Glaucoma
What are Some of the Available Nursing Care Plans for Glaucoma?
Nursing Care Plan 1
Nursing Diagnosis: Disturbed Visual Sensory Perception related to altered status of the eyes and vision secondary to glaucoma, as evidenced by blurry vision, eye pain, eye redness, and patchy blind spots on the peripheral and central visual fields on both eyes.
Desired Outcome: The patient will maintain current visual acuity without further vision loss.
|Assess the patient’s current visual acuity and visual field.||To establish current visual acuity and visual field and to customize interventions based on this initial assessment.|
|Discuss the possibility of loss of vision and allow the patient to express his/her feelings towards it.||Early intervention and treatment of glaucoma can help prevent further vision loss. However, the patient is still at risk for partial or complete vision loss. Discussing feelings and thoughts about this can help the patient appropriately grieve, while establishing rapport with the healthcare team and becoming encouraged to follow the agreed treatment plan.|
|Administer the eye drops as prescribed.||Eye drops for glaucoma are prescribed to constrict pupillary constriction and reduce the intraocular pressure, thereby reducing further vision loss. Depending on the target eye pressure, the patient may be prescribed one or more of the following: prostaglandins, beta blockers, alpha adrenergic agonists, carbonic anhydrase inhibitors, and rho kinase inhibitors.|
|Teach the patient on how to properly administer them and educate him/her the right schedule to administer the drops daily as prescribed. Allow the patient to demonstrate the procedure.||Educating the patient and allowing him/her to demonstrate the procedure encourages the patient to take ownership of his/her healthcare, as well as enables the nurse to determine good eye drop administration technique, or correct any mistake in doing the procedure.|
|Prepare for surgical intervention intended for glaucoma. Surgical interventions to treat glaucoma include:Laser TherapyIridectomy Filtering surgery Drainage tubes Minimally invasive glaucoma surgery||To prevent further loss of vision.|
Nursing Care Plan 2
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of glaucoma as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of glaucoma and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. blurry vision).||To address the patient’s cognition and mental status towards the new diagnosis of glaucoma and to help the patient overcome blocks to learning.|
|Explain what glaucoma is, its types, and related signs and symptoms. Avoid using medical jargons and explain in layman’s terms.||To provide information on glaucoma and its pathophysiology in the simplest way possible.|
|Educate the patient about safety measures related to glaucoma. Create a plan for Activities of Daily Living (ADLs) with the patient and the caregiver especially including important activities such as driving, operating machinery, swimming, and bathing.||To encourage the patient to live his/her daily life optimally, while ensuring that he/she is safe from injury despite having this condition.|
|Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to manage glaucoma. Ask the patient to repeat or demonstrate the self-administration details to you.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.|
|Encourage the patient to make lifestyle changes such as:Eat a healthy dietExercise safely Limit caffeine intakeIncrease oral fluid intakeSleep with head elevatedTake prescribed medications for glaucoma||To enable to patient to have an optimal quality of life.|
May be related to
- Physiological factors, change in health status; presence of pain; possibility/reality of loss of vision
- Unmet needs
- Negative self-talk
Possibly evidence by
- Apprehension, uncertainty
- Expressed concern regarding changes in life events
- Appear relaxed and report anxiety is reduced to a manageable level.
- Demonstrate problem-solving skills.
- Use resources effectively.
|Evaluate anxiety level, degree of pain experienced or suddenness of onset of symptoms, and current knowledge of the condition.||These factors affect the patient’s perception of threat to self, potentiate the cycle of anxiety, and may interfere with medical attempts to control IOP.|
|Give accurate, honest information. Discuss the probability that careful monitoring and treatment can prevent additional visual loss.||Lessens anxiety related to unknown or future expectations, and provides a factual basis for making informed choices about treatment.|
|Allow the patient to acknowledge concerns and express feelings.||Provides an opportunity for the patient to deal with the reality of the situation, clarify misconceptions, and problem-solve concerns|
|Identify helpful resources and people.||Provides reassurance that patient is not alone in dealing with the problem.|
Other nursing diagnoses:
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.