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Glaucoma | 마이메르시 MyMerci
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Glaucoma

NCLEX Review Guide: Glaucoma

Pathophysiology & Types

Understanding Glaucoma

  • Glaucoma is characterized by increased intraocular pressure (IOP) leading to optic nerve damage and progressive visual field loss if untreated.
  • Primary open-angle glaucoma is the most common type, developing gradually with no early symptoms, often called the "silent thief of sight."
  • Angle-closure glaucoma is a medical emergency requiring immediate intervention to prevent permanent vision loss within hours.

Memory Aid: GLAUCOMA

  • Gradual vision loss (open-angle)
  • Loss of peripheral vision first
  • Acute emergency (angle-closure)
  • Undetected until advanced
  • Compliance with eye drops crucial
  • Optic nerve damage irreversible
  • Miotic drops constrict pupil
  • Annual eye exams essential

Key Points

  • Normal IOP: 10-21 mmHg; glaucoma suspected when >21 mmHg
  • Vision loss is irreversible - early detection is critical
  • Peripheral vision lost first, central vision preserved until late stages

Clinical Manifestations

Open-Angle vs. Angle-Closure Glaucoma

Open-Angle Glaucoma Angle-Closure Glaucoma
• Gradual, painless vision loss
• Tunnel vision
• Halos around lights
• No acute symptoms		 • Severe eye pain
• Sudden vision loss
• Nausea/vomiting
• Headache
• Seeing halos
• Hard, red eye

Clinical Scenario

A 65-year-old patient reports difficulty seeing cars in peripheral vision while driving and bumping into objects. These symptoms suggest open-angle glaucoma with characteristic peripheral vision loss.

Emergency Alert: Angle-closure glaucoma with severe eye pain, nausea, and sudden vision changes requires immediate ophthalmology consultation!

Nursing Management & Medications

Pharmacological Interventions

  1. Prostaglandin analogs (latanoprost) - First-line treatment, administered once daily in evening
  2. Beta-blockers (timolol) - Reduce aqueous humor production, check for respiratory contraindications
  3. Carbonic anhydrase inhibitors - Decrease aqueous humor production, monitor for sulfa allergies
  4. Miotic agents (pilocarpine) - Constrict pupil to improve drainage, may cause blurred vision

Eye Drop Administration Technique

  1. Wash hands thoroughly
  2. Tilt head back, pull lower eyelid down
  3. Instill drop into conjunctival sac (not directly on cornea)
  4. Apply gentle pressure to inner canthus for 1-2 minutes
  5. Wait 5 minutes between different eye medications

Key Points

  • Compliance with daily eye drops is essential to prevent vision loss
  • Systemic absorption can occur - monitor for cardiac/respiratory effects with beta-blockers
  • Teach patients to never stop medications abruptly

Patient Education & Safety

Lifestyle Modifications & Safety Measures

  • Educate about importance of regular eye exams every 1-2 years for early detection and monitoring.
  • Instruct patients to avoid activities that increase IOP such as heavy lifting, straining, or inverted positions.
  • Emphasize medication compliance and proper eye drop technique to maintain therapeutic levels.
  • Teach patients to modify home environment with adequate lighting and removal of hazards to prevent falls.

Quick Check

Patient asks: "Can I still drive with glaucoma?"
Answer: Depends on visual field testing results and disease progression. Encourage discussion with ophthalmologist and consider driving evaluation if peripheral vision is significantly affected.

Key Points

  • Family history increases risk - encourage screening for relatives
  • African Americans have higher risk and earlier onset
  • Diabetes and hypertension are additional risk factors

Common Pitfalls & Study Tips

Frequently Confused Concepts

Often Confused With Key Differences
Cataracts Cataracts cause cloudy/blurry central vision; glaucoma causes peripheral vision loss
Macular Degeneration Macular degeneration affects central vision first; glaucoma affects peripheral vision first

NCLEX Success Tips

  • Remember: Angle-closure = EMERGENCY
  • Prostaglandin analogs are given in evening (once daily)
  • Beta-blockers in eyes can cause systemic effects (bradycardia, bronchospasm)
  • Vision loss is irreversible - prevention is key

Self-Assessment Checklist

  • ☐ Can I differentiate between open-angle and angle-closure glaucoma?
  • ☐ Do I know the proper eye drop administration technique?
  • ☐ Can I identify when glaucoma is a medical emergency?
  • ☐ Do I understand medication compliance importance?
  • ☐ Can I teach patients about lifestyle modifications?

Remember: You're preparing to be a safe, competent nurse who can preserve patients' precious gift of sight. Every concept you master brings you closer to passing NCLEX and making a difference in patients' lives. Stay focused and confident!

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