Lippincott Certification Review Medical-Surgical Nursing

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Glaucoma

Box 18-1: Types of Cataracts

There are several forms of cataracts. They occur at various points in the life cycle, but the treatment for each is the same. Type of Cataract Description Complicated Develop as secondary effects in patients with uveitis, glaucoma, retinitis pigmentosa, or retinal detachment or with systemic disease, such as diabetes, hypoparathyroidism, or atopic dermatitis; also develop after exposure to ionizing radiation or infrared rays.

Congenital

Develop in utero at the anterior or posterior ocular pole; associated with heredity or maternal rubella infection in the first trimester. Occur after age 50 as part of aging; the nuclear portion of the lens becomes increasingly dense, transparency decreases, and light rays strike the opaque lens and scatter. Result from drug or chemical toxicity with dinitrophenol, ergot, naphthalene, or phenothiazines. Can occur at any age and are caused by mechanical trauma or exposure to chemicals, radiation, or toxic substances; the capsule ruptures, swelling occurs, and opacity increases; usually unilateral.

Senile

Toxic

Traumatic

Glaucoma

●● Description ●● This group of disorders is often characterized by high IOP and optic nerve damage that affects peripheral vision. ●● There are two main forms of glaucoma: ●● Open-angle (also known as chronic, simple , or wide angle ) glaucoma begins insidiously and progresses slowly. ●● Up to 40% of primary open-angle glaucoma has a normotensive IOP. There is commonly evidence of optic nerve or retinal nerve fiber layer damage and evidence of visual field abnormalities. ●● Angle-closure (also known as acute or narrow angle ) glaucoma occurs suddenly and can cause permanent vision loss in 48 to 72 hours. ●● Signs and symptoms ●● Open-angle glaucoma may cause no symptoms, or it may cause a dull morning headache, mild aching in the eyes, loss of peripheral vision, halos around lights, and reduced visual acuity (especially at night) that’s uncorrected by glasses. ●● Acute angle-closure glaucoma causes the rapid onset of pain and pressure over the eye, blurred vision, decreased visual acuity, halos around lights, and nausea and vomiting. ●● Diagnosis and treatment ●● Tonometry measurements reveal increased IOP; visual field tests measure loss of peripheral vision. ●● Ophthalmoscopy shows the effects of glaucoma on the optic disc (called cupping), whereas gonioscopy measures the angle of the anterior chamber of the eye. ●● Other diagnostic tests may include slit-lamp examination and fundus photography. ●● Drugs that may be used to treat glaucoma include topical adrenergic agonists, cholinergic agonists, beta adrenergic blockers, and topical or oral carbonic anhydrase inhibitors that reduce IOP by decreasing the production of aqueous humor. ●● Surgery or laser treatments may be performed for patients who are unresponsive to drug therapy (see Procedures for glaucoma , page 314). ●● Bed rest is recommended for patients with acute angle-closure glaucoma. No new support found. ●● Nursing interventions ●● Encourage patient adherence by teaching the patient about the disease process and treatment. ●● Since glaucoma is a “silent disease,” adherence is especially important. Open-angle glaucoma is a top cause of blindness worldwide. ●● Postoperatively, give medications, as ordered, to dilate the pupil and topical corticosteroids to rest the pupil and protect the affected eye. ●● Administer pain medication, antiemetics, and stool softeners, as ordered. ●● Encourage the patient to be ambulatory immediately after surgery. ●● Teach the patient to avoid activities that can increase IOP such as straining during bowel movements.

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