A nurse is caring for a client with acute angle-closure glaucoma. Which nursing intervention should be the highest priority?

Administering miotic eye drops (e.g., pilocarpine) is the highest priority to constrict the pupil, open the drainage angle, and rapidly reduce intraocular pressure, preventing permanent vision loss. Other interventions like pain management or surgery are secondary.

Clinical Priority in Acute Angle-Closure Glaucoma

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].