Glaucoma is group of diseases in which the pathophysiology is not fully understood. It is also a condition which remains largely asymptomatic until it is in its advanced stages. At its most basic level of understanding, the pressure in the eye on the optic nerve increases, which leads to cellular death and ultimately vision loss. The mechanisms in which the pressure increases differs between the different kinds of glaucoma. We will discuss the two most common.
Open-angle and angle-closure are the most common kinds. Open-angle accounts for approximately 90% of cases. It occurs over a long period of time. Slowly, drainage canals become clogged, which results in higher pressure. This can happen so slowly that the patient doesn’t even realize the visual deterioration is occurring until it’s quite advanced.
The second most common kind of glaucoma, angle-closure, is a sudden condition that comes on quickly and requires immediate treatment. It is usually related to some sort of eye trauma. This must be treated immediately and is considered a medical emergency, as permanent blindness can occur without appropriate treatment.
Because the most common kind of glaucoma occurs slowly over years without symptoms, screenings are essential. This is why a glaucoma test is routine in eye exams, even for young adults.
The exact cause of glaucoma is unknown. As far as the most common type of glaucoma, open-angle, the theory is that the drainage system of the eye becomes insufficient over time and subsequent pressure builds up.
Age (over 60), race, genetics/family history, eye injury, other eye pathology, as well as corticosteroid use are all risk factors for glaucoma.
Decrease intraocular pressure as quickly as possible, prevent further visual damage.
Glaucoma Nursing Care Plan
**May be asymptomatic
- Hazy vision
- Seeing bright lights
- Sudden sight loss
- Severe eye pain
- Slow visual changes
Nursing Interventions and Rationales
Prevent further compromised vision
- Must report changing assessment findings to the provider promptly, especially with angle-closure glaucoma because timing is a factor in preventing permanent blindness.
Prevent injury: initiate fall precautions, remove any tripping hazards
- Due to compromised vision, patients may not be able to see tripping hazards or objects in their way. Remove as much clutter, cords, rugs, etc. as possible to make the area as safe as it can be. This is especially important in the patient with sudden visual changes, as they have not slowly adapted over years as one may have with progressive loss.
Appropriately assess vision
- You must know the degree of visual compromise so that you are able to tell if it has changed.
Educate about appropriate eye drop administration
- Post-procedure or during long-term management, patients are frequently on various various eye drops. It’s essential they understand thoroughly which drops to administer when, how to do so appropriately. They may need additional intervention with color-coding bottles because they may not be able to clearly read labels. Ensure support systems are equally aware of regimen.
Educate about importance of follow-up care
- Compliance is key! Patients must follow be compliant with their treatment regimen to prevent further deterioration.
- Patients can have sudden pain, which will increase their intraocular pressure, making the problem even worse.
- A sudden inability to see or the new knowledge that you will have a degree of blindness is upsetting. Provide as much education and emotional support as possible, and if necessary, administer medications.