Glaucoma is a group of eye conditions caused by abnormally high eye pressure eventually damaging the nerve that is responsible for good vision called optic nerve.
Glaucoma is one of the major causes of blindness among the elderly but can still happen at any age.
Various types of glaucoma have no signs and symptoms until its advanced stages.
Lifetime treatment and monitory are required. Blindness caused by glaucoma cannot be reversed so it is vital to have regular eye check ups, which include eye pressure monitoring, for early diagnosis and treatment.
Signs and Symptoms of Glaucoma
Signs and symptoms of glaucoma depend on the type and stage of the condition:
- Open angle glaucoma
- patchy blind spots on the peripheral and central visual fields on both eyes
- tunnel vision (advanced stage)
- Acute angle closure glaucoma
Other Signs and Symptoms Include:
- Severe headache
- Eye pain
- Nausea and vomiting
- Blurred vision
- Halos around lights
- Eye redness
Causes and Risk Factors of Glaucoma
Glaucoma is the result of optic nerve deterioration causing blind spots in the visual field.
This is commonly related to increased intra ocular pressure caused by the accumulation of aqueous humour flowing inside the eye.
It normally drains through a trabecular meshwork where the iris and cornea meet but, when it is over produced or if the drain malfunctions, the pressure also increases.
Glaucoma is believed to be a genetic condition and scientists have discovered that some people have a specific gene related to increased intra ocular pressure.
There are five types of glaucoma: Open angle glaucoma, Angle closure glaucoma, Normal tension glaucoma, Glaucoma in children, Pigmentary Glaucoma.
1. Open angle glaucoma. It is the most common form of the disease. The drainage angle formed by the cornea and the iris stays open but the trabecular meshwork is partially blocked. This causes gradual increase in eye pressure and is barely noticeable, even until the person is actually aware of the problem.
2. Angle closure glaucoma. This occurs when the iris bulges forward to block the drainage angle, thus preventing eye fluid circulation and increasing eye pressure. Some people already have narrow drainage angles, putting them at higher risk for this type of glaucoma. This may happen gradually or suddenly and is considered as a medical emergency.
3. Normal tension glaucoma. In this type of glaucoma, the optic nerve is damaged despite having normal eye pressure. The exact cause is unknown. The person may have a sensitive optic nerve or have less blood supply to the optic nerve. This may be caused by atherosclerosis or other conditions that impede circulation.
4. Congenital glaucoma. It is also possible for children and infants to have glaucoma either from birth or in the first few years of life and can be caused by drainage blockage or some underlying medical condition.
5. Pigmentary glaucoma. It is characterized by the build up of pigment granules from the iris into the drainage channels, blocking fluid from exiting the eye. Activities such as jogging increase the production of these granules and cause intermittent increase in eye pressure.
The risk factors for developing glaucoma include:
- High internal eye pressure
- Age 60 and over
- Race: Black, Asian, Hispanic
- Family history of glaucoma
- Medical conditions such as diabetes, heart disease, high blood pressure, and sickle cell anemia
- Thin-centred corneas
- Extreme near-sightedness or far-sightedness
- Previous eye injury or surgery
- Long-term corticosteroid use (could be in eye drop form)
Diagnosis of Glaucoma
The doctor will review the patient’s medical history and conduct a series of tests including:
- Tonometry – to measure intra ocular pressure
- Dilated eye exam and imaging tests – to check for optic nerve damage
- Eye chart test – to check for areas of visual loss
- Pachymetry – to measure corneal thickness
- Gonioscopy – to inspect the drainage angle
Treatment for Glaucoma
- Eye drops. The eye drops help improve fluid drainage or decrease amount of fluid produced by the eye. Depending on the target eye pressure, the patient may be prescribed one or more of the following:
- Prostaglandins – increase outflow of fluid in the eyes; side effects include mild eye reddening and stinging, iris darkening, eyelashes or eyelid skin darkening, and blurred vision
- Beta blockers – reduce eye fluid production; side effects include difficulty of breathing, hypotension, bradycardia, impotence, and fatigue
- Alpha adrenergic agonists – increase outflow of fluid in the eye and reduce aqueous humour production; side effects include irregular heart rate, hypertension, fatigue, red, itchy or swollen eyes, and dry mouth
- Carbonic anhydrase inhibitors – reduce fluid production; side effects include metallic taste, urinary frequency, and tingling in fingers and toes
- Rho kinase inhibitors –reduce fluid build-up; side effects include eye redness, or eye discomfort
- Mitotic or cholinergic agents -increase fluid outflow; side effects include headache, eye ache, smaller pupils, blurred vision, and near-sightedness
Oral medications. If eye drops are insufficient, oral medications like a carbonic anhydrase inhibitor will be prescribed.
Surgery. Surgical interventions to treat glaucoma include:
Laser Therapy, such as argon laser trabeculoplasty (ALT), trabeculectomy or trephination
Iridectomy
Filtering surgery
Drainage tubes
Minimally invasive glaucoma surgery
If left untreated, glaucoma will eventually lead to blindness.
However, despite treatment, about 15% of glaucoma patients are at risk for developing blindness in 20 years.
If a person experiences any of the above symptoms of acute angle closure glaucoma, it is best to proceed to the local hospital’s emergency department or seek and ophthalmologist as soon as possible.
Nursing Diagnosis for Glaucoma
Nursing Care Plan for Glaucoma 1
Nursing Diagnosis: Disturbed Visual Sensory Perception related to altered status of the eyes and vision secondary to glaucoma, as evidenced by blurry vision, eye pain, eye redness, and patchy blind spots on the peripheral and central visual fields on both eyes
Desired Outcome: The patient will maintain current visual acuity without further vision loss.
| Glaucoma Nursing Interventions | Rationale |
| Assess the patient’s current visual acuity and visual field. | To establish current visual acuity and visual field and to customize interventions based on this initial assessment. |
| Discuss the possibility of loss of vision and allow the patient to express his/her feelings towards it. | Early intervention and treatment of glaucoma can help prevent further vision loss. However, the patient is still at risk for partial or complete vision loss. Discussing feelings and thoughts about this can help the patient appropriately grieve, while establishing rapport with the healthcare team and becoming encouraged to follow the agreed treatment plan. |
| Administer the eye drops as prescribed. | Eye drops for glaucoma are prescribed to constrict pupillary constriction and reduce the intraocular pressure, thereby reducing further vision loss. Depending on the target eye pressure, the patient may be prescribed one or more of the following: prostaglandins, beta blockers, alpha adrenergic agonists, carbonic anhydrase inhibitors, and rho kinase inhibitors. |
| Teach the patient on how to properly administer them and educate him/her the right schedule to administer the drops daily as prescribed. Allow the patient to demonstrate the procedure. | Educating the patient and allowing him/her to demonstrate the procedure encourages the patient to take ownership of his/her healthcare, as well as enables the nurse to determine good eye drop administration technique, or correct any mistake in doing the procedure. |
| Prepare for surgical intervention intended for glaucoma. Surgical interventions to treat glaucoma include:Laser TherapyIridectomy Filtering surgery Drainage tubes Minimally invasive glaucoma surgery | To prevent further loss of vision. |
Nursing Care Plan for Glaucoma 2
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of glaucoma as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of glaucoma and its management.
| Glaucoma Nursing Interventions | Rationales |
| Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. blurry vision). | To address the patient’s cognition and mental status towards the new diagnosis of glaucoma and to help the patient overcome blocks to learning. |
| Explain what glaucoma is, its types, and related signs and symptoms. Avoid using medical jargons and explain in layman’s terms. | To provide information on glaucoma and its pathophysiology in the simplest way possible. |
| Educate the patient about safety measures related to glaucoma. Create a plan for Activities of Daily Living (ADLs) with the patient and the caregiver especially including important activities such as driving, operating machinery, swimming, and bathing. | To encourage the patient to live his/her daily life optimally, while ensuring that he/she is safe from injury despite having this condition. |
| Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to manage glaucoma. Ask the patient to repeat or demonstrate the self-administration details to you. | To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details. |
| Encourage the patient to make lifestyle changes such as:Eat a healthy dietExercise safely Limit caffeine intakeIncrease oral fluid intakeSleep with head elevatedTake prescribed medications for glaucoma | To enable to patient to have an optimal quality of life. |
Nursing Care Plan for Glaucoma 3
Nursing Diagnosis: Anxiety related to change in health status secondary to glaucoma, as evidenced by severe headache, nausea, uncertainty, and expressions of concern regarding life event changes.
Desired Outcomes:
- The patient will be able to demonstrate a relaxed state and report that anxiety is reduced to a manageable level.
- The patient will be able to gain problem-solving skills.
- The patient will be able to utilize readily available resources effectively.
| Glaucoma Nursing Interventions | Rationale |
| Assess the patient’s anxiety level, the severity of the patient’s discomfort or the development of symptoms, and the knowledge of the problem. | These variables influence the patient’s perception of self-threat, amplifying the anxiety cycle and perhaps interfering with medical attempts to regulate intraocular pressure. |
| Provide the patient with accurate and truthful facts. Discuss if careful monitoring and therapy can help avoid further vision loss. | Reduces anxiety associated with uncertain or future expectations and gives a factual foundation for making treatment decisions. |
| Allow the patient to express fears and feelings. | Allows the patient to cope with the truth of the issue, explain misconceptions, and address problems. |
| Identify significant people from the patient’s circle and useful resources. | Assures that the patient is not alone in coping with the situation. |
| Maintain a calm, non-threatening behavior when interacting with the patient. | Anxiety is contagious, and it may be passed from one health care worker to another. In the presence of a calm staff member, the patient develops a sense of security. |
| Establish a trusting relationship with the patient by listening to the patient, demonstrating warmth, immediately answering questions, expressing unconditional acceptance, being available, and respecting the patient’s usage of personal space. | Because the nurse, who is a stranger, may constitute a threat to the very nervous client, therapeutic skills must be aimed toward putting the patient at ease. |
| Provide the patient with a calm, low-stimulation small room with well lightning and free from hazardous things that might put the patient at risk for injury. | External cues exacerbate anxious behavior. In comparison to a vast space, which might make the client feel disoriented and terrified, a smaller or secluded environment improves a sense of security and allows faster familiarization of object placement. |
| Maintain a positive behavior when dealing with the patient. | If the nurse is well-mannered and confident in control of the problem, the patient will feel more safe. |
| Provide the patient with reassurance and comfort measures | Assists the patient with anxiety relief. |
| Stay with the patient during panic episodes and use concise, straightforward instructions. | During a panic attack, the patient needs to know that he is not dying and that the symptoms will go away on their own. The patient’s capacity to deal with abstractions or complexity is impaired by anxiety |
| Avoid asking or pressuring the patient to make decisions. | The patient may be unable to make sensible and suitable judgments, or even make any decisions at all. |
| Assess the patient’s visual acuity. | Understanding where the patient’s eyesight was before to the present assessment can identify how much the patient’s vision has altered. |
| Recommend methods to help the patient handle visual restrictions, such as clearing clutter, moving furniture out of the way, tilting the head to see subjects, and compensating for weak light and night vision impairments. | Reduces the risk of accidents caused by changes in visual fields/vision loss and papillary adjustment to ambient light. It will also encourage the patient to move independently and be able to do daily activities in their own phase. |
| Encourage your patient to participate in relaxation methods such deep breathing, gradual muscular relaxation, and meditation. | These are examples of readily available resources and methods that the patient may utilize in reducing the anxiety. |
Nursing Care Plan for Glaucoma 4
Nursing Diagnosis: Risk for Injury related to poor vision secondary to glaucoma, as evidenced by expressions of sudden decrease in vision, sensitivity to light, fear of falling, and eye pain.
Desired Outcomes:
- The patient will be able to perform tasks that are within the limits of sensory limitation.
- The patient will be able to be free of injury.
- The patient and or family will be able to do alterations on the environment to ensure patient safety.
| Glaucoma Nursing Interventions | Rationale |
| Determine the extent of the patient’s visual impairment. | Increases awareness of the problem and determines its severity, allowing for the creation of a treatment plan. |
| Ensure that the patient’s room is well-lit and that the furniture is pushed towards the walls. Remove all carpets and any other potentially dangerous items. | Reduces the risk of injury by providing a safe atmosphere. |
| Maintain easy access to the patient’s spectacles and the call bell. | Provides patient support as well as good visual acuity. |
| Instruct the patient and/or family on the importance of maintaining a secure environment. | The patient is at risk of damage due to reduced visual acuity. |
| Instruct the patient and/or family about proper lighting. To decrease glare, the patient should wear sunglasses. Encourage the family to decorate with contrasting bright colors. | These strategies improve visual discrimination while lowering the risk of damage. |
| Assess the patient’s home surroundings for any threat to safety. | Patients with decreased vision acuity, and other cognitive functioning abnormalities, are vulnerable to common dangers. Slips, trips, and falls among older people with a history of falls or functional disability are often linked to domestic dangers (Fares, 2018). Throw rugs, clutter, inappropriate storage of cleaning supplies or chemicals, incorrect storage of prescriptions, inadequate lighting, and other items that put the patient at danger of harm may be identified in the patient’s home. |
| Utilize alternatives to restraints as needed to avoid falls and injuries. | Alarm systems with ankle or wrist bands, alarms for bed or wheelchairs, careful and regular monitoring of the patient, secured unit doors, keeping the bed low, and other alternatives to restraints may be used. |
| Place the patient in a room that is close to the nurse’s station. | Moving the patient’s room closer to the nursing station helps the health care provider to keep a close eye on individuals who are at danger of injury or falling and intervene quickly. |
| Ensure that there are no things on the floor that might cause the patient to slip or fall. | To ensure the patient’s safety and assist the patient in doing everyday tasks. |
| Remind the patient to come in for a checkup the day after surgery. | Because the patient will be released once recovered from anesthesia. Remind the patient to stay away from activities that raise intraocular pressure. |
| Instruct the patient to put a perforated plastic or metal shield over the eye during the day; a shield or glasses should be used for protection. | To prevent unintentional harm to the eye. |
| Validate the patient’s thoughts and sentiments about environmental hazards. | Validation assures the patient that the nurse has heard and comprehended his or her concerns. It also aids in the development of the nurse-patient connection. |
| Instruct the patient with vision impairments and the carers to put brightly colored labels, such as yellow or red, in prominent locations in the surroundings that must be easily identified (e.g., stair edges, stove controls, light switches). | If the patient needs to get up at night, lighting an unfamiliar location might aid boost visibility. Patients with vision impairment can safely traverse the surroundings by using bright colors and allocating them to items. Bright colors are simpler to perceive visually. |
| Educate the patient how to use antibiotic ointment or drops, as well as how to use steroids. | To prevent infections and inflammation. |
| Instruct the patient to keep a look out for problems including severe pain in the eye that isn’t relieved by analgesics or anterior chamber clouding. | This might be a sign of infection and should be reported right away. |
| Advise the patient to wear sunglasses when going outside. | To help protect the eyes and reduce the glare. |
| Educate the patient on safe ambulation at home, including the use of safety features like grab bars in the bathroom and nonslip, well-fitting footwear, and urge them to ask for help. | Home safety should be evaluated, addressed with patients and caregivers, and taken into account periodically when making choices about the patient’s future care in order to maximize their health results. In order to promote functional and independent living and prevent harm, it is critical to educate the patient and caregiver on home environment modification. |
Nursing Care Plan for Glaucoma 5
Risk for Ineffective Therapeutic Regimen
Nursing Diagnosis: Risk for Ineffective Therapeutic Regimen related to the complexity of treatment regimen secondary to glaucoma.
Desired Outcomes:
- The patient will be able to verbalize the desire to follow the treatment regimen and improve the health status.
- The patient will be able to identify necessary resources and use them.
- The patient will be able to show increased interest in health-promoting activities.
| Glaucoma Nursing Interventions | Rationale |
| Assess any associated situations that may have a negative impact on the program’s success. | The identification of causal causes directs future intervention. This might be anything from a lack of funds to physical restrictions. |
| Determine the patient for any previous attempts to stick to a routine. | This information is a great start when trying to figure out how to implement the treatment plan. |
| Assess the patient’s belief in the capacity to carry out the desired activity. | According to the self-efficacy hypothesis, positive belief in one’s ability to do an activity favorably is linked to performance and success. |
| Assess the patient’s personal views on health issues. | According to the Health Belief Model, the patient’s perceived vulnerability to disease, as well as the severity and danger of disease, impact treatment program compliance. Cultural occurrences and legacy may also impact how individuals see health. |
| Assess the patient’s capacity to do the intended task. | The quantity and type of instruction that must be provided depends on the patient’s capacity to perform the activity. |
| Determine if the patient can absorb or recognize the planned health-related activity. Allow the patient to participate in the treatment planning process. | Cognitive limitations must be identified in order to develop an appropriate alternative strategy. Alternative actions can be taken once problems have been categorized. Patients who actively participate in their treatment have a better chance of achieving a favorable outcome. |
| Educate the patient about the benefits of sticking to the suggested treatment plan. | Patients who comprehend the treatment’s success in reducing risk or promoting health are more inclined to use it. |
| Explain the regimen in a way that the patient can understand. Long-acting drugs are recommended, and needless prescriptions should be avoided. | If prescriptions must be taken numerous times each day, patients are more prone to ignore them. |
| Explain post-operative limitations to the patient including lifting over 5lb, bending forward or straining until cleared by physician. | Such activities may increase intraocular pressure. |
| Review with the patient the procedure for eye drops and have the patient or family member demonstrate installations afterwards. Supplement verbal instructions with written information. | Correct administration of medications will help in a faster healing process. |
| Explain to the patient about how the treatment’s side effects or negative side effects can be managed or minimized. | This decides whether or not anything needs revision. |
| Concentrate on the behavior that will contribute the most to the therapeutic impact. | Changing one’s behavior is never simple. Efforts should be focused on activities that are known to have certain advantages |
| Refer the patient to a support group if the patient’s support system is inadequate during the next treatment regimen. | Patients suffering with visual impairment may benefit from groups that get together for mutual support and information. |
| Include significant others in the explanations and instruction. Encourage their participation and cooperation in the implementation of the treatment plan. | Significant others’ involvement fosters support and aid in reinforcing suitable habits and fostering lifestyle change. |
| Develop a reward system with the patient for effective follow-through. | Verbal acknowledgement, monetary awards, special privileges such as an earlier office appointment, free parking, or phone calls are all possible rewards. These will help the patient to do the task correctly. |
| Create a system that allows the patient to track their own development. | Self-monitoring is essential for successful behavior modification. |
More Glaucoma Nursing Diagnosis
- Eye Pain
- Powerlessness
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
