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GLAUCOMA
Vaisakh. GI Year MSc. Nursing,AIMS,kochi.
Glaucoma is a group of ocular disease characterized by,
1. Increased Intraocular pressure(IOP)
2. Optic nerve atrophy
3. Peripheral visual field loss
EPIDEMIOLIOGY
Leading cause of blindness in the World., In India, 3rd most common cause of blindness after cataract and refractive errors.
• Most prevalent among men than women.
• “Once lost vision in glaucoma it cannot normally be
recovered”
Glaucoma has been called as “SILENT THIEF”.
ETIOLOGY
• Congenital genetic malformations
• Diabetic retinopathy
• Occular trauma
• Corticosteroids
ETIOLOGY
A balance between the rate of aqueous humor production (referred to as inflow) and the rate of reabsorption (referred to as outflow) is essential to maintain the IOP within normal limits.
Normal IOP- 10 to 21mmHg> 21mmHg in Glaucoma
When the rate of inflow is greater than the rate of outflow, IOP can rise above normal limits .
The indirect theory suggest that High IOP compresses the microcirculation in the optic nerve head , resulting in cell injury and death.
Angle Anatomy
Normal Physiology
90% of fluid flows out of the anterior
chamber draining through the spongy
trabecular meshwork
Canal of schelm and the episcleral veins
c - Iris outflow
a - Conventional outflow-90%b - Uveoscleral outflow
STAGES
Initiating events
Structural alterations in aqeous outflow system
Functional alterations(increased IOP and impaired blood flow )
Optic nerve damage
Visual loss
• Pressure in the anterior and posterior chambers pushes the lens back and puts pressure on the vitreous body
• the vitreous body presses the retina against the choroid and compresses the blood vessels that feed the retina
• Without sufficient blood supply retinal cells die and optic nerve atrophy and blindness
TYPES OF GLAUCOMA
Primary
• Open angle (Normal tension glaucoma)• Closed angle
Secondary
• Inflammatory• Traumatic
PRIMARY OPEN ANGLE GLAUCOMA
PRIMARY CLOSED ANGLE GLAUCOMA
PRIMARY NARROW ANGLE GLAUCOMA
SECONDARY GLAUCOMA
•Ocular or Systematic conditions that may be associated with inflammatory processes that block the outflow channels such as trauma and ocular neoplasms.
CLINICAL MANIFESTATIONS
Gradual peripheral visual lose (Tunnel
vision)
Sudden excruciating pain around eye
Nausea and vomiting
Corneal edema due to rise in IOP
Symptoms
1. Severe eye/headache
2.Blurred vision
3. Red eye
4.Nausea and vomiting
5.Halos around lights
6.Intermittent eye ache
at night
Signs
1.Red, teary eye
2.Mid-dilated, fixed pupil
3..Iris atrophy
DIAGNOSTIC EVALUATION
Gonioscopy
Visual Acuity test
Slit lamp microscopy
Ophthalmoscopy
OPTIC DISK DAMAGE
MANAGEMENT
DRUG THERAPYBeta blockers (Timolol)
Alpha – Adrenergic Agonist
Cholinergic agents
Carbonic anhydrase inhibitors
Prostaglandin Derivatives
(Xalatan,Lutanoprost)
SURGICAL MANAGEMENT
•Canaloplasty
•Trabeculectomy
• Glaucoma Drainage implant
Laser surgery
Argon Laser Trabeculoplasty
Selective Laser Trabeculoplasty
Laser peripheral iridotomy (Nd: YAG)
Diode Laser Cycloablation
Laser-assisted Nonpenetrating Deep Sclerectomy
NURSING MANAGEMENT
Health promotion
Early Detection
Ophthalmic examination for
every 4 yrs age between 60 and 64 yrs
every 1-2 yrs for >65yrs of age
Acute intervention Cold compress Calm and Quiet environment
Ambulatory home care
CATARACT
A cataract is a lens opacity or cloudiness. Cataract
rank behind arthritis and heart disease as a
leading cause of disability in older adults. Lens appears Grey or milky.
EPIDEMIOLOGY Cataract is leading cause of blindness in the world. - WHO- Cataract affects nearly 1 in every 6 peoples of age above 40yrs.
By 80yrs of age, more than half of all have cataract.
Most cataracts are age related called as “SENILE CATARACT”
ETIOLOGYAge related- Senile cataractAltered metabolic process leads to accumulation of Yellow- brown pigments and alterations in the lens fiber structure.
Other causes areo Blunt or Penetrating Injuryo Maternal Rubellao Radiation (or) UV Light Exposureo Systemic Corticosteroidso Patients with Diabetes Mellitus
TYPES OF SENILE CATARACT
.
Nuclear cataract
Cortical Cataract
Posterior subcapsular
cataracts.
Nuclear cataract
Nuclear cataract is associated with genetic component.
It causes central opacity of lens.
Myopia worsens when cataract
progresses.
Eye glasses can be used.
Cortical cataractIt involves the anterior, posterior or equatorial
cortex of the lens. It doesnot interfere with passage of light through the center of the lens and has little effect on vision.
• Vision is worse in light.
• Peoples with highest levels of sunlight
exposure have twice the risk of developing
cortical cataracts.
Posterior subcapsular cataract
It occurs infront of the posterior capsule. Common in younger adults. Associated with prolonged use of corticosteroids use, DM, occular trauma.
Near vision is diminished and eye is
extremely sensitive to glare from bright light.
CLINICAL MANIFESTATIONS
Decrease in vision
Abnormal color presentation
Glare worsens at night when pupils dialates
Brunescens color values shift to Yellow-brown.
DIAGNOSTIC EVALUATIONOphthalmoscopic examination or Slit Lamp microscopic examination.
A totally opaque lens creates the appearance of white pupil.
MANAGEMENT No nonsurgical medications, eyedrops, eyeglasses treatment cures cataract.
In the earlier stages of cataract development- glasses, contact lenses, bifocal magnifying lenses may improve vision.
Surgical management is the treatment of choice….
SURGICAL MANAGEMENT
Intracapsular Cataract Extraction
Extracapsular Cataract Extraction
Extracapsular cataract extraction
1. Anterior capsulotomy
2. Completion of incision
3. Expression of nucleus
4. Cortical cleanup
6. Polishing of posterior capsule, if appropriate
5. Care not to aspirate posterior capsule accidentally
8. Grasping of IOL and coating with viscoelastic substance
Extracapsular cataract extraction ( cont. )
7. Injection of viscoelastic substance
9. Insertion of inferior haptic and optic
11. Placement of haptics into capsular bag
10. Insertion of superior haptic
12. Dialling of IOL into horizontal position
and not into ciliary sulcus
Phacoemulsification
Phacoemulsification
1. Capsulorrhexis 2. Hydrodissection
3. Sculpting of nucleus 4. Cracking of nucleus
5. Emulsification of each quadrant
6. Cortical cleanup and insertion of IOL
Lens Replacement Surgery
NURSING MANAGEMENT
• Preoperative care
• Intraoperative care
• Postoperative care
• Followup care
COMPLICATIONS
Retinal detachment
Endophthalmitis
Corneal edema and Crystoid macular edema
Posterior capsular opacification
RELATED RESEARCH STUDYData from two case control studies in Oxfordshire were
combined and analysed by in oxfordshire by J J Harding and M Egerton on Diabetes, glaucoma, sex and cataract. This study covered 1940 subjects 723 cases and 1217 controls,– reveals that Diabetes was shown to be a powerful risk factor for cataract with a relative risk of 5.04. More than 11% of cataracts was attributable to Diabetes and also found that relative risk of glaucoma as a risk factor for cataract.
Glaucoma is a powerful and independent risk factor for cataract in both sexes and may be responsible for 5% of all cataracts .
CONCLUSION
SUMMARY
REFERENCE