Glaucoma 180813151731
Glaucoma 180813151731
Glaucoma 180813151731
NO PAGE
INDEX NO
1 INTRODUCTION 1
2 DEFINITION 1
3 INCIDENCE 1
5 TYPES 5
6 ETOLOGY 7-8
7 PATHOPHYSIOLOGY 9
8 CLINICAL MANIFISTRATION 10
9 DIAGNOSTIC EVALUATION 11
10 MANAGEMENT 11-15
1-MEDICAL MANAGMENT
2-SURGICAL MANAGEMENT
11 16
3-NURSING MANAGEMENT
12 BIBLIOGRAPHY 18
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GLAUCOMA
INTRODUCTION :-
Glaucoma damages the eye's optic nerve. It is a leading cause
of blindness in the United States. It usually happens when the fluid pressure inside the
eyes slowly rises, damaging the optic nerve.
Definition :-
3) “A disease of the eye in which the pressure of fluid inside the eyeball is
abnormally high, caused by obstructed outflow of the fluid. The increased pressure
can damage the optic nerve and lead to partial or complete loss of vision.”
- www.thefreedictionary.com
4) Glaucoma is a group of ocular conditions characterized by optic nerve damage. The
optic nerve damage is related to the intra ocular pressure (IOP) caused by
congestion of aqueous humor in the eye.
- Bruner & Suddarth’s
Incidence :-
Glaucoma is the leading cause of irreversible blindness. In fact, as
many as 6 million individuals are blind in both eyes from this disease.
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Anatomy & physiology of eye :-
The eye is the organ of the sense of sight situated in the orbital cavity & it is
supplied by the optic nerve i.e. 2 nd cranial nerve. It is almost spherical in shape & is about
2.5 cm in diameter. The space between the eye & the orbital cavity is occupied by adipose
tissue. The bony walls of the orbit & the fat help to protect the eye from injury.
STRUCTURE OF EYE :-
There are 3 layers of tissue in the walls of the eye. They are :-
1) The outer fibrous layer : Sclera & Cornea
2) The middle vascular layer or uveal tract : Coroid,Ciliary body & iris
3) The inner nervous tissue layer : Retina
Structures inside the eyeball are the lens, aqueous fluid (humour) & Vitreous body
(humour).
SCLERA:-
The sclera or white of the eye, forms the outer most layer of tissue of the
posterior & lateral aspects of the eyeball & is continuous anteriorly with the transparent
cornea. It consists of a firm fibrous membrane that maintains the shape of the eye & gives
attachment to the extra ocular or extrinsic muscles of the eye.
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Function of Sclera :-
1. The sclera is an outer fibrous layer that encases and protects the eyeball.
2. It completely envelops the globe except at the front of the eye and maintains the
shape of the globe.
3. It also provides a firm anchorage for the extra ocular muscles that control the eye's
movement.
CORNEA:-
Anteriorly the sclera continuous as a clear transparent epithelial
membrane, the cornea. Light rays pass through the cornea to reach the retina. The cornea
is convex anteriorly & is involved in refracting or bending light rays to focus them on the
retina.
Function of Cornea:-
1. It helps to shield the rest of the eye from germs, dust, and other harmful matter. The
cornea shares this protective task with the eyelids, the eye socket, tears, and the sclera, or
white part of the eye
2. The cornea acts as the eye's outermost lens. It functions like a window that controls and
focuses the entry of light into the eye. The cornea contributes between 65-75 percent of
the eye's total focusing power.
CHOROID :-
It is very rich in blood vessels & is deep chocolate brown in color. Light
enters the eye through the pupils, stimulates the nerve endings in the retina & is then
absorbed by the choroid.
Function of Choroid:-
1. It absorbs light and prevents internal reflection.
2. The choroid provides oxigen and nourishment to the outer layers of the retina.
CILIARY BODY:-
It is the anterior continuation of the choroid consisting of ciliary
muscles & secretary epithelial cells. It gives attachment to the suspensory ligament which,
as its other end, is attached to the capsule enclosing the lens. The epithelial cells secrete
aqueous fluid into the anterior segment of the eye, i.e.the space between the lens & the
cornea (anterior & posterior chambers).The ciliary body is supplied by parasympathetic
branches of the oculomotor nerve i.e. 3 rd cranial nerve.
Functions of Ciliary Body:-
The ciliary body has three functions:
1. accommodation,
2. aqueous humor production and
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3. the production and maintenance of the lens zonules.
It also anchors the lens in place.
Accomommodation essentially means that when the ciliary muscle contracts, the
lens becomes more convex, generally improving the focus for closer objects. When
it relaxes, it flattens the lens, generally improving the focus for farther objects.
4. One of the essential roles of the ciliary body is also the production of the aqueous
humor, which is responsible for providing most of the nutrients for the lens and the
5. cornea and involved in waste management of the areas.
IRIS :-
The iris is the visible colored part of the eye & extends anteriorly from the
ciliary body, lying behind the cornea in front of the le The eye into Anterior & Posterior
chambers, which contain aqueous fluid secreted by the ciliary body. It is a circular body
composed of pigment cells & 2 layers of smooth muscles fibers –one circular & the other
radiating. In the centre there is an aperture called the pupil. The iris is supplied by
parasympathetic & sympathetic nerves. Parasympathetic stimulation constricts the pupil
& Sympathetic stimulation dilates it.
Functions of Iris :-
1. It controls how much light enters the eye. At night or in a dark room for example,
we need more light to see, so the pupil dilates to allow more light to enter. Another
factor plays a role here, when the pupil was constricted (before you entered the
dark room) the light was focused on the central retina, where there are almost no
rods (rods are sensitive to light, basically we need the to see where there is
minimum illumination).Now, the cones in the central retina are not sensitive to
light, so when the iris dilates the pupil so the light could get to the rods.
LENS :-
The lens is a highly elastic circular biconvex body, behind the pupil. It
consist of fibers enclosed thin a capsule. Its thickness is controlled by the ciliary muscles
through the suspensory ligament. The lens has three main parts: the lens capsule, the lens
epithelium, and the lens fibers. The lens capsule forms the outer most layer of the lens
and the lens fibers form the bulk of the interior of the lens. The cells of the lens epithelium
located between the lens capsule and the outermost layer of lens fibers, are found only on
the anterior side of the lens.
LENS CAPSULE :- The lens capsule is a smooth, transparent basement membrane that
completely surrounds the lens. The capsule is elastic and is composed of collagen
LENS EPITHILIUM :- The lens epithelium, located in the anterior portion of the lens
between the lens capsule and the lens fibers, is a simple cuboidal epithelium.
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LENS FIBERS :- The lens fibers are long, thin, transparent cells, firmly packed, with
diameters typically between 4-7 micrometers. It divides the anterior segment of
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The eye into Anterior & Posterior chambers, which contain aqueous fluid secreted by the
ciliary body. It is a circular body composed of pigment cells & 2 layers of smooth muscles
fibers –one circular & the other radiating. In the centre there is an aperture called the
pupil. The iris is supplied by parasympathetic & sympathetic nerves. Parasympathetic
stimulation constricts the pupil & Sympathetic stimulation dilates it.
Functions of Iris :-
2. It controls how much light enters the eye. At night or in a dark room for example,
we need more light to see, so the pupil dilates to allow more light to enter. Another
factor plays a role here, when the pupil was constricted (before you entered the
dark room) the light was focused on the central retina, where there are almost no
rods (rods are sensitive to light, basically we need the to see where there is
minimum illumination).Now, the cones in the central retina are not sensitive to
light, so when the iris dilates the pupil so the light could get to the rods.
LENS :-
The lens is a highly elastic circular biconvex body, behind the pupil. It
consist of fibers enclosed thin a capsule. Its thickness is controlled by the ciliary muscles
through the suspensory ligament. The lens has three main parts: the lens capsule, the lens
epithelium, and the lens fibers. The lens capsule forms the outer most layer of the lens
and the lens fibers form the bulk of the interior of the lens. The cells of the lens epithelium
located between the lens capsule and the outermost layer of lens fibers, are found only on
the anterior side of the lens.
LENS CAPSULE :- The lens capsule is a smooth, transparent basement membrane that
completely surrounds the lens. The capsule is elastic and is composed of collagen
LENS EPITHILIUM :- The lens epithelium, located in the anterior portion of the lens
between the lens capsule and the lens fibers, is a simple cuboidal epithelium.
LENS FIBERS :- The lens fibers are long, thin, transparent cells, firmly packed, with
diameters typically between 4-7 micrometers and lengths of up to 12 mm long.
Functions of lens :-
1. It focuses the image by bending the light to strike the retina correctly. This is also
called refraction.
2. The cells of the lens epithelium regulate most of the homeostatic functions of the
lens.
3. The iris controls the size of the pupil.
4. It controls the amount of light entering the eye.
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RETINA :-
The retina is the inner most layer of the wall of the eye. it is an extremely
structure & is specially adapted for stimulation by light rays. It is composed of several
layers of nerve cells bodies& their axons, lying on a pigmented layer of epithelial cells,
which attach it to the choroid. The layer highly sensitive to light is the layer of sensory
receptor cells: rods & cones. The rods & cones contain photosensitive pigments that
convert light rays into nerve impulses. The small area of retina where the optic nerve
leaves the eye is the optic disc or blind spot. It has no light sensitive cells.
Functions of retina :-
1. The retina is the photosensitive part of the eye. The light sensitive nerve cells are
the Rods & Cones. Light rays cause chemical changes in photosensitive pigments in
these cells & they generate nerve impulses which are conducted to the occipital
lobes of the cerebrum via the optic nerves.
2. The Rods are more sensitive than the Cones. They are stimulated by low intensity or
dim light.eg. by the dim light in the interior of a darkened room.
3. The Cones are sensitive to bright light & color. The different wave length of visible
light stimulates photosensitive pigments in the cones, resulting in the perception of
different colors. The rods are more numerous towards the periphery of the retina.
Visual purple (Rhodesian) is a photosensitive pigment present only in the rods. It is
bleached (degraded) by bright light & is quickly regenerated when an adequate
supply of vitamin A is available.
Types :-
Glaucoma
Primary Secondary
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Congenital infantile buphthalmos hydrophthalmos :-
3) Childhood glaucoma :-
Childhood glaucoma is an uncommon pediatric condition often
associated with significant visual loss. It may most commonly be caused by trauma,
surgery or other acquired or secondary causes or abnormal increase intra ocular
pressure.
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5) Pigmentary glaucoma :-
In this granules of pigment detach from the iris, which is the colored
part of the eye. These granules then may block the trabecular meshwork, is a key
element in the drainage system of the eye. Finally the blocked drainage system leads to
elevated intraocular pressure which results in damage to the optic nerve.
6) Exfoliative glaucoma :-
This type of glaucoma is characterized by deposits of flaky material on
the front surface of the lens (anterior capsule) & in the angle of the eye. The
accumulation of this material in the angle is believed to block the drainage system of
the eye and raise the eye pressure.
Etiology :-
-Aqueous humor is a clear fluid in the front
Part of the eye.
-Vitreous humor is a clear, jelly-like substance
That fills the eye behind the lens and helps
The eyeball keeps its shape.
-In a normal eye, aqueous humor is produced,
Circulates through the eye and then drains
Out through the trabecular meshwork, which
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is the eye's filtration system. This is a series
Of tiny channels near the angle formed by
The cornea (the clear portion of the eye), the
Iris (the colored portion of the eye) and the
Sclera (the white of the eye).
-If there is any sort of blockage in these channels, pressure builds up inside the eyeball .
Risk factors :
1) Age over 45 years
2) Family history of glaucoma
3) Diabetes
4) History of elevated intra-ocular pressure
5) Near-sightedness (Myopia)
6) Use of steroids
7) Thin cornea
8) A history of severe anemia or shock
9) Cardiovascular disease
10) Eye trauma
11) Race
12) Abnormally high intra-ocular pressure
13) Peripheral vision is decreased.
14) Provision eye injury
15) Not seeing a rainbow.
Clinical manifestation :-
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1) Severe eye pain
2) Eye redness
3) Blurred vision
4) Severe headache
5) Nausea
6) Vomiting
7) Dry eyes with itching or burning
8) Dark spot at the center of viewing
9) Excess tearing or watery eyes
10) Difficulty focusing on near or distant object
Path physiology :-
There are 2 accepted theories regarding how increased IOP damages the optic
nerve in glaucoma.
The direct mechanical theory suggests that high IOP damages the retinal layer as it
passes through the optic nerve head.
The indirect ischemic theory suggests that high IOP compresses the microcirculation
in the optic nerve head, resulting in cell injury & death.
Some glaucoma’s appear as exclusively mechanical & some are exclusively ischemic
types. Typically most cases are a combination of both.
1) Ocular & medical history to investigate the the history of predisposing factors.
5) Perimeter:-To assess the visual fields. The visual fields to detect any early (or late)
signs of glaucomatous damage to the optic nerve. Visual fields are measured by a
computerized assessment.
6) pachymetry:-It is a relatively new test being used for the diagnosis and treatment
of glaucoma.Pachymetry determines the thickness of the cornea.
After the eye has been numbed with anesthetic eyedrops,the pachymeter tip is
touched lightly to the front surface of the eye (cornea).Recent studies have shown
that corneal thickness can affect the measurement of intraocular pressure.
Medical management :-
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Surgical management :-
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3) Filtering procedures :- ( for chronic glaucoma)
These are used to create an opening or fistula in the
trabecular meshwork to drain aqueous humor from the anterior chamber to the
subconjunctival space, thereby bypassing the usual drainage structures. This allows
the aqueous humor to flow & exit by different routes.
4) Trabeculectomy :-
It is the standard filtering technique used to remove part of the
trabecular meshwork. Complication include hemorrhage,loe or elevated
IOP,cataract etc.
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5) Drainage implants or shunts :-
These are an open tubes implanted in the anterior
chamber to shunt aqueous humor to an attached place in the conjunctiva space. A
fibrous capsule develops around the episcleral plate & filters the aqueous humor,
thereby regulating the outflow & controlling IOP.
6) Canaloplasty :-
Canaloplasty utilizes a micro catheter or tube placed in the Canal of Schlemm
(the natural site of drainage for healthy eyes) to enlarge the drainage canal,
relieving pressure inside the eye. Studies have been published demonstrating long-
term efficacy and safety
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7) Diode laser cycloablation :-
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Nursing management :-
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Nursing intervention:-
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3) Assessment: - Evaluate patient for nausea & vomiting.
Nursing diagnosis: - Nausea & vomiting related to opioids & other medications.
Nursing goal: - Provide antiemetic drugs, thereafter Client will have Relieving from
Nausea & vomiting .
Nursing intervention:-
Evaluation: - Patient will relieve from Nausea & vomiting, after taking antiemetic
Drugs.
2) SMELTZER SUZANNE C., BARE BRENDA (2004), BRUNNER & SUDDARTH’S TEXTBOOK
OF MEDICAL SURGICAL NURSING, 10TH EDITION, LONDON: LIPPINCOTT WILLIAMS
& WILKINS.
4) www.wrongdiagnosis.com
5) www.ehealthmd.com
6) www.glaucomafoundation.org
7) www.webmd.com
8) en.wikipedia.org
9) www.answer.com
10) www.enotes.com
11) Medicaldictionary.thefreedictionary.com
12)www.patient.co.uk
13)www.emedicinehealth.com
14)www.healthline.com
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