Glaucoma

Glaucoma

• A group of disorders characterized by
  • Increased IOP and consequences of elevated pressure
  • Optic nerve atrophy
  • Peripheral visual field loss
• Second leading cause of blindness in U.S.
• Leading cause of blindness in African Americans
  • Many are unaware
  • Incidence increases with age
  • Preventable
  • Genetic traits

Etiology and pathophysiology

• Primary open-angle glaucoma (POAG)
  • Most common type of glaucoma
  • Outflow of aqueous humor is ↓ in trabecular meshwork
  • Develops slowly
  • No symptoms
  • Unnoticed until peripheral vision is severely compromised
• Primary angle-closure glaucoma (PACG)
  • Angle closure ↓ the flow of aqueous humor
  • Caused by age, pupil dilation
  • Possibly drug induced

Clinical manifestation

• PACG
  • Sudden onset
    • Excruciating pain in or around eyes
    • Nausea and vomiting
    • Seeing colored halos around lights
    • Blurred vision
    • Ocular redness
  • IOP elevated in glaucoma
    • Normal IOP 10 to 21 mm Hg
    • Open-angle glaucoma 22 to 32 mm Hg
    • Acute angle-closure glaucoma >50 mm Hg

Interprofessional Care

• Acute angle-closure glaucoma
  • Miotics
    • Decreased visual acuity in dim light
  • Oral/IV hyperosmotic
  • Laser peripheral iridotomy
  • Surgical iridectomy