A nurse is caring for a client with acute angle-closure glaucoma. Which nursing intervention should be the highest priority?
A 65-year-old client presents to the emergency department with severe eye pain, blurred vision, and nausea. The client reports seeing halos around lights and has a rock-hard eyeball upon palpation.
1Administer prescribed analgesics for pain relief
2Prepare the client for immediate ophthalmologic intervention✓ 정답
3Apply cool compresses to the affected eye
4Educate the client about long-term glaucoma management
해설
Acute angle-closure glaucoma is an ophthalmologic emergency requiring immediate intervention to prevent permanent vision loss. Preparing for ophthalmologic intervention is the priority over pain management, cool compresses, or education.
The correct answer is 2. Prepare the client for immediate ophthalmologic intervention.
Rationale
Acute angle-closure glaucoma (AACG) is a true ophthalmologic emergency where the normal outflow of aqueous humor is abruptly blocked. In this condition, the iris bulges forward and seals off the trabecular meshwork, causing a rapid, dangerous rise in intraocular pressure (IOP). The client's presentation—severe eye pain, blurred vision, halos around lights, nausea, and a rock-hard eyeball—is a classic and critical cluster of symptoms. The nausea is a vagal response to the extreme ocular pain and elevated pressure, not a primary gastrointestinal issue. The highest priority is to rapidly lower the IOP to prevent irreversible optic nerve damage and permanent vision loss, which can occur within hours.
The provided evidence underscores the urgency and the definitive nature of the required intervention. The case report by Vivarelli et al. [1] describes a patient presenting with bilateral AACG and critically elevated IOPs of 57 mmHg and 50 mmHg (normal IOP range is typically 10-21 mmHg). Their management protocol involved immediate discontinuation of the causative agent and emergent measures to break the acute attack, a process that begins with medical stabilization followed promptly by definitive interventions like laser iridotomy. The study by Onal et al. [2] further reinforces this by detailing a treatment pathway where patients with AACG first undergo "medical stabilization of IOP and inflammation" before proceeding to definitive surgical correction with phacoemulsification within one month. This two-phase approach—immediate medical pressure reduction followed by a procedure to restore aqueous flow—highlights that the nurse's critical role is to prepare for and facilitate this time-sensitive intervention.
The other options are incorrect because they do not address the underlying pathophysiology and the emergent nature of the crisis. Administering analgesics (Option 1) is a comfort measure that does nothing to halt the progressive optic nerve damage from unrelieved pressure. Applying cool compresses (Option 3) is a non-pharmacological comfort intervention with no effect on IOP and dangerously delays definitive care. Educating the client about long-term management (Option 4) is an important nursing intervention but is completely inappropriate during the acute phase of a sight-threatening emergency; this teaching is provided only after the acute attack is broken and the IOP is controlled. The immediate nursing priority is to recognize the condition as an emergency and collaborate with the healthcare team to facilitate the treatments—such as IOP-lowering medications and preparing for laser or surgical procedures—that will definitively resolve the angle closure and preserve vision [1,2].
References (research sources)
[1]
Bilateral Simultaneous Acute Angle-Closure Glaucoma Following Over-the-Counter Cold Medication.Research articleVivarelli C, Pellegrini M, Parmeggiani F, Adamo GG, Gallenga CE, Ferri P, Mura M. (2026) · DOI: 10.1155/crop/8847063
[2]
Anterior Segment Changes after Lens Extraction in Acute Angle-Closure Glaucoma Assessed by Scheimpflug Tomography.Research articleOnal I, Baydemir EE, Yildirim Y. (2026) · DOI: 10.3341/kjo.2025.0069
Clinical Priority: Acute Angle-Closure Glaucoma
Immediate Assessment
Recognize the classic triad: severe unilateral eye pain, blurred vision with halos, and nausea/vomiting (vagal response).
Palpate the globe gently; a "rock-hard" eye indicates critically elevated intraocular pressure (IOP), often >40 mmHg.
Assess visual acuity and pupil reactivity; the affected pupil is typically mid-dilated and non-reactive.
Emergency Nursing Interventions
Notify the ophthalmologist immediately and prepare for emergency evaluation; this is a time-sensitive threat to vision.
Position the client supine with the head elevated 30-45 degrees to promote aqueous drainage.
Administer prescribed IOP-lowering medications, which may include topical pilocarpine, beta-blockers, alpha-agonists, and systemic acetazolamide or mannitol.
Prepare for definitive laser peripheral iridotomy once the acute attack begins to break; ensure informed consent and pre-procedure setup.
Ongoing Monitoring and Safety
Monitor IOP response to treatment; a rapid decline is the goal.
Assess for pain relief and resolution of nausea as IOP normalizes.
Protect the unaffected eye; prophylactic laser iridotomy is often indicated due to high bilateral risk.
Educate the client on avoiding anticholinergic medications and low-light environments that can precipitate future attacks.
Acute Angle-Closure Glaucoma — An ophthalmic emergency where the iris blocks the trabecular meshwork, abruptly preventing aqueous humor drainage and causing a rapid, dangerous rise in intraocular pressure.
Intraocular Pressure — The fluid pressure inside the eye, normally 10-21 mmHg; extreme elevation can cause irreversible optic nerve damage within hours.
Laser Iridotomy — A definitive procedure that creates a small hole in the iris to restore aqueous humor outflow and resolve the angle-closure attack.