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Glaucoma Info

QuestionAnswer
Glaucoma ocular diseases resulting in increased IOP
Patho increased IOP reduces blood flow to optic nerve & retina
Primary glaucoma (causes) aging, genes, central retinal vein occlusion
Secondary glaucoma (causes) Uveitis, iritis, neovascular disorder, trauma, ocular tumor, degenerative disease, eye surgery
Associated glaucoma (causes) DM, HTN, severe myopia, retinal detachment
Open-angle glaucoma gradual increase in IOP/decrease in visual fields
Open-angle patho fluid cannot leave the eyes at same rate it’s produced
Angle-closure glaucoma sudden onset, EMERGENCY
Angle-closure patho narrowed angle & forward displacement of iris onto cornea; narrows/closes chamber angle which obstructs fluid outflow
S/S of emergent situation sudden, severe pain around eyes radiating over face; NV; headache/brow px
Early glaucoma s/s increased IOP, diminished accommodation
Late glaucoma s/s diminished visual fields, decreased acuity (glasses ineffective), halos, headache, eye px (acute), increased cup-disc ratio, pale optic disc
Opthalmoscopic results Shallow anterior chamber; Cloudy aqueous humor; Moderately dilated/non-reactive pupil
Tonometry Measures IOP; closed-angle >30mmHg; open-angle 22-32mmHg
Tonography Outflow measured w/ weight on globe; Normal-steep downward tracing; Glaucoma-flat tracing
Gonioscopy helps view drainage angle in anterior chamber; entire 360 circumference is viewed
Non-surgical management focus on prevention & early detection, topical agents to reduce ocular HTN can delay/prevent damage
Drug therapy goals reduce IOP by (1) improve flow of AH to absorption site, (2) reduce production of AH
Pilocarpine - Class Direct-acting cholinergic; Miotic
Pilocarpine - Action Constrict pupils and contract ciliary muscle
Direct-acting cholinergic teaching vision may be blurry for 1-2 hours; low-light vision can be diminished; report s/s of systemic effects
Timoptic (timolol) - Class beta-blocker
Timoptic (timolol) - Action decrease IOP by reducing AH production w/o pupillary constriction
Diamox (acetazolamide) - Class carbonic anhydrase inhibitor
Diamox (acetazolamide) - Action maintains low IOP by reducing AH production
Propine (dipivefrin HCl) - Class Sympathomimetic
Propine (dipivefrin HCl) - Action decrease production of AH which decreases IOP (converted to epi in eye)
Propine (dipivefrin HCl) - Contraindication Angle-closure glaucoma b/c it dilates pupil
Surgical management laser surgery, standard surgical procedure
Laser surgery (indication) open-angle glaucoma refractory to meds & angle-closure glaucoma
Laser for Open-angle (procedure) laser burns trabecular meshwork, causing fibers to tighten, increasing intra-fiber space, resulting in improved outflow
Laser for Angle-Closure (procedure) laser creates hole near edge of iris, allowing AH to flow from posterior chamber to anterior chamber to drainage meshwork
Laser Pre-op care inform pt about procedure, expected sights/sounds, expected outcomes
Laser Post-op care pt needs a driver, re-eval IOP 1 hr post-procedure & before discharge, ocular steroid may be prescribed
Standard surgery (indications) open-angle refractory to meds & laser; angle-closure (some cases)
Standard procedure creation of new drainage channel or destruction of production structures; followed by antibiotic injection under conjunctiva & eye-patch
Standard Post-op Teaching No ASA, avoid lying on operative side, report brow px/severe eye px/nausea
Standard Complication choroidal hemorrhage (S/S acute deep eye px, decreased vision, changes in VS)
Created by: jlee12406
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