# Situation: A 63-year-old woman is brought to the emergency department at night with sudden severe pain in the left eye, headache, blurred vision and vomiting that began while she sat in a dark theater. The left eye is red, the cornea is hazy, and the pupil is mid-dilated and does not react to light. She undergoes laser peripheral iridotomy of the left eye. Which statement by the client shows correct understanding?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630445  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 63-year-old woman is brought to the emergency department at night with sudden severe pain in the left eye, headache, blurred vision and vomiting that began while she sat in a dark theater. The left eye is red, the cornea is hazy, and the pupil is mid-dilated and does not react to light.

She undergoes laser peripheral iridotomy of the left eye. Which statement by the client shows correct understanding?

## 보기

1. "The vision I lost in this attack will come back as the eye heals."
2. "My right eye may need the same laser to prevent an attack." **✔ 정답**
3. "I can take my usual cold tablets now that the eye is treated."
4. "I should rest in a darkened room whenever my eye aches."

**정답: 2**

## 해설

Laser peripheral iridotomy is the definitive treatment for acute angle closure, and the fellow eye, which shares the same anatomy, is often treated prophylactically. Vision lost from optic nerve damage cannot be restored, and drugs or conditions that dilate the pupil can precipitate an attack.

## 심화 해설

What laser peripheral iridotomy does
Laser peripheral iridotomy creates a small opening in the outer iris. Aqueous humor can then flow from behind the iris to the front without passing through the pupil, which relieves the pupillary block that pushed the iris forward and closed the drainage angle. Iridotomy is the definitive treatment for acute angle closure, and the fellow eye, which shares the same narrow anatomy, is often treated prophylactically. The client's statement that her right eye may need the same laser shows correct understanding.

Why the other eye is at risk
Angle closure usually occurs in eyes with a naturally shallow anterior chamber and narrow angle, a feature that is typically present in both eyes. An acute attack in one eye therefore signals a high risk of a future attack in the other. Prophylactic iridotomy of the untreated eye prevents that attack. Until it is done, the right eye remains vulnerable.

| Client statement | Accurate? | Reason |
| --- | --- | --- |
| Lost vision will come back | No | Optic nerve damage is irreversible |
| Right eye may need the same laser | Yes | The fellow eye has the same narrow angle |
| Usual cold tablets are fine now | No | Antihistamines and decongestants can dilate the untreated eye |
| Rest in a darkened room for eye ache | No | Darkness dilates the pupil and can trigger closure |

Teaching after an attack
Glaucoma damages the optic nerve, and vision already lost does not return; treatment protects the vision that remains. Some cold and allergy products contain antihistamines or decongestants that can dilate the pupil, and the untreated right eye can still close, so she should check any such drug with the prescriber or pharmacist first. Dim light dilates the pupil, the very trigger of her attack, so eye pain, halos, or blurred vision require prompt medical care rather than rest in the dark.

Watch out! A darkened room sounds restful and is the advice for many eye conditions, but in angle-closure glaucoma darkness is a trigger. Pain with halos or blurred vision is an emergency.

Exam takeaway
Key point! After iridotomy, the fellow eye is often treated too, lost vision does not return, and drugs or conditions that dilate the pupil must be avoided until both eyes are protected.

## 임상 시나리오

Teaching After Laser IridotomyProtecting both eyes
Laser peripheral iridotomy opens a path for aqueous humor through the iris and is the definitive treatment for acute angle closure.

The other eye usually has the same narrow angle, so prophylactic laser of the right eye is often advised.

Vision lost from optic nerve damage does not return. Cold medicines with antihistamines or decongestants and dim light can dilate the pupil and trigger an attack.

CautionEye pain, halos, or blurred vision need urgent care; resting in a dark room can worsen angle closure.

## 핵심 개념

- **Laser peripheral iridotomy** — A laser hole in the outer iris that equalizes pressure across the iris and opens the drainage angle.
- **Fellow eye** — The other eye of a client who has a disease in one eye.
- **Pupillary block** — Obstruction of aqueous flow through the pupil that bows the iris forward and closes the angle.
- **Mydriasis** — Dilation of the pupil, which can precipitate angle closure in a narrow-angle eye.

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