GLAUCOMA

OVERVIEW

• Glaukoma penyakit pada mata di mana terjadi kerusakan pada saraf optik dan menyebabkan gangguan penglihatan.

• Most, but not all, caused by elevated pressure inside the eye.

• Elevated IOP = ocular hypertension.

OVERVIEW

GLAUCOMA CAUSES

Aqueous humor provides structural support, oxygen, and nutrition to the tissues within the eye. (eMedicineHealth.com, 2009)

GLAUCOMA CAUSES (Cont)

• The exact causes of optic nerve damage from glaucoma is not fully understood, but involves mechanical compression and/or decreased blood flow of the optic nerve.

• Although high eye pressure mostly lead to glaucoma, many people can also get it with the normal eye tension.

(University of Michigan Site, 2009)

GLAUCOMA CAUSES (Cont)

Normal aqueous humor drainage (eMedicineHealth.com, 2009)

Optic Nerve Damage

Optic Nerve Damage

Glaucoma Facts and Stats

• Glaucoma can cause blindness if it’s untreated, and unfortunately about 10% of those who receive treatment from the professional still lost their vision.

• There is no cure (yet) for glaucoma, but it is possible to halt further loss of vision. Since glaucoma is a chronic condition, it must be monitored for life.

• Everyone is at risk for glaucoma.• There may be no symptoms to warn.

(Glaucoma.org, 2009)

Risk for Glaucoma

• African-Americans, 6-8x more common than Caucasians.

• People over 60 years, 6x more likely.• Family members with glaucoma, 4-9x at risk,

especially primary open angle glaucoma which is hereditary.

• Steroid users.• Eye injury• High myopia, diabetes, hypertension, central

cornea thickness less than 0,5 mm(Glaucoma.org, 2009)

Types of Glaucoma

• Open-angle glaucoma

• Angle-closure glaucoma

• Low-tension or normal-tension glaucoma

• Congenital glaucoma

• Secondary glaucoma

• Others type glaucoma (e.g. pigmentary, traumatic, neovascular, pseudoexfoliative glaucoma)

Open and Closure Angle Glaucoma

SYMPTOMS

• Most people with glaucoma do not experience any symptoms till they began loss their vision significantly.

• Small blind spots may began to develop, usually in the peripheral vision.

• Other symptoms related to the raised IOP, include blurred vision, halos around the lights, severe eye pain, headache, nausea, and vomiting.

(eMedicineHealth.com, 2009)

SYMPTOMS

• The following may be indications of potentially serious problems that might require emergency medical attention:– Sudden loss of vision in one eye– Sudden hazy or blurred vision– Flashes of light or black spots– Halos or rainbows around light

Visual associated with glaucoma

Normal eye

The glaucoma eye

EXAMS and TESTS

• Tonometry test• Ophthalmoscpy• The “air puff” test• Perimetry• Genioscopy• Dilated eye exam• Optic Nerve Computer Imaging

TREATMENT

• Glaucoma CANNOT BE CURED, but it CAN BE CONTROLLED.

• Treatment is aimed to lower the pressure within the eye reduce production or increase outflow of the aqueous humor.

• Medications and surgery are used, depend on the type and severity of the case.

TREATMENT: Medications

• Beta-blockers (such as timolol) and carbonic anhydrase inhibitors, can reduce the amount of aqueous humor produced.

• Alpha-adrenergic agonists, such as brimonidine, decrease the production of aqueous humor and also improve the drainage of it.

• Prostaglandins and cholinergic can increase drainage of aqueous humor.

TREATMENT: Surgery

• Laser surgery:– Laser peripheral iridotomy (angle-closure

glaucoma) a drainage hole is created in the iris in order to relieve the increased pressure inside the eye.

– Laser trabeculoplasty (primary open angle glaucoma) helps fluid drain out the eye. On anesthetized eye, there will be a special lens hold to the eye. Then a high-intensity beam of lights is aimed at the lens and reflected onto the meshwork inside the eye the laser makes several evenly spaced burns that stretch the drainage hole in the meshwork fluid drains better.

Laser Iridotomy

Laser Trabeculoplasty

Laser Surgery (Cont)

• Like any surgery, laser surgery can cause side effects, such as inflammation the doctor may give some take-home drops for any soreness or inflammation within the eye.

• Only one eye will be treated at a time laser treatments for each eye will be scheduled several days to several weeks apart (National Eye Institute, 2009).

TREATMENT: Surgery (Cont)

• Conventional surgery:– It makes a new opening for the fluid to leave

the eye.– Often is done after medicines and laser

surgery have failed to control the pressure.– This surgery also followed by take-home

drops to prevent any infection and inflammation inside the eye.

– The surgery can cause side effects, such as cataract, problems with the cornea, and inflammation of infection inside the eye.

Conventional Surgery

National Eye Institute, 2009)

NURSING IMPLICATION

• At least one week after surgery, patients are advised to keep water out of the eye.

• Daily activities can be done, but it is important to avoid driving, reading, bending, and doing any heavy lifting increase the IOP.

• Giving an adequate information about glaucoma: what it is, the causes, the treatment, and the most important thing is about their responsibility within the treatment.

NURSING IMPLICATION (Cont)

• Glaucoma is about participating in the treatment, it cannot be cured, but it can be controlled.

• Make sure the patient understand about their type of glaucoma and the treatment, the medications info (the name, frequency, time to have it, route of use the med., and the effect).

• Protect the eye, keep it clean and free from irritant, avoiding to shake the eye, using glasses when swimming or at a danger work.

REFERENCES

• The National Eye Institute, Glaucoma, http://www.nei.nih.gov/health/glaucoma/glaucoma_facts.asp#1a, accessed 13 September 2009, 2.00 PM.

• Glaucoma Research Foundation, http://www.glaucoma.org/, accessed 13 September 2009, 1.55 PM.

• Noecker, RJ, Glaucoma Overview, http://www.emedicinehealth.com/glaucoma_overview/article_em.htm, accessed 19 September 2009, 12.32 PM.

• The University of Michigan, Glaucoma, http://www.kellogg.umich.edupatientcareconditionsglaucoma.html, accessed 19 September 2009, 12.40 PM.

• Smeltzer and Bare, ????, BA Kep. Medikal Bedah, Edisi 8 Vol. 3, Jakarta: EGC.

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