Chronic glaucoma, also known as primary open-angle glaucoma (POAG), is often described as a thief of sight, the reason being that people affected by the disease do not have any warning signs, pain or other indications that something is wrong prior to an extensive loss in vision (Watkinson, 2010). Chronic glaucoma is said to affect as many as half the Americans and most people do not even know that they are affected. In definition, chronic glaucoma is an inconsistency in the production and drainage of the clear fluid named the aqueous humor which has the function to fill the eye’s anterior chamber. Glaucoma is mainly described as a functional or structural commotion of the optic nerve that could cause patients to have a progressive or a permanent loss of vision (Watkinson, 2010). Most commonly, increased pressure of the fluid in the eye results in optic nerve damage and consequential to neuropathy of the optic nerve lead to adverse changes in vision. Furthermore, the intra ocular pressure (IOP) can cause impairment to the optic nerve either in an unexpected attack or gradually over a period of time (Watkinson, 2010).
Glaucoma can be primarily divided into two categories, the chronic open-angle glaucoma and the acute closed-angle glaucoma (CAG). Open-angle glaucoma, the most well-known type of glaucoma, is a disorder in which the fluid pressure in the eye steadily rises and diminishes blood movement to the optic nerve. Open-angle glaucoma leading to increased IOP is usually caused by inadequate drainage of eye fluids. There are rarely any signs and symptoms inadequate drainage of eye fluids except that there is a gradual loss of vision from both eyes. In more advanced phases of the open-angle glaucoma, patient may possibly complain of a tunnel vision.
The other type of glaucoma is the acute closed-angle glaucoma (CAG). This kind of glaucoma being called acute closed-angle can be explained by the fact that there is a sudden rise intraocular pressure inside the eyes stocked with aqueous humor buildup. The IOP, as in the OAG, can damage the optic nerve. The onset of the symptoms in CAG is abrupt. There is one-sided severe pain in eyes and patient may complain of photophobia, nausea, headaches, haziness in the visual field, pain, and an increase in glare when driving at night. The affected patients also see halos around lights as well as reddening of the eye. Moreover, blurred vision, caused by a sudden rise in eye pressure, and an increased glare when driving at night, can occur. The complaint that a large number of patients describe is “shade being drawn down over the eye,” which is a unilateral, not bilateral, appearance. The patients typically present with gradual alteration of vision. However, prior to the patient noticing any apparent signs and symptoms, for example peripheral vision loss, the glaucoma was already quite advanced (Watkinson, 2010).
During the assessment of patients with chronic open or acute close-angle glaucoma, the nurse practitioner should be aware of the risk factors of the disease. Ocular hypertension is one of the major causes of chronic open-angle glaucoma which can be explained by a raise in the pressure of the eye without glaucomatous optic nerve damage or visual field loss. Other risk factors include patients being over the age of 60, history of glaucoma, increased cup-disc ratio, Black African or Black Caribbean origin and Hispanic ethnicity (James, 2014). Furthermore, other risk factors are patient with thin central corneal thickness, which can cause underestimation of IOP. Especially in the patient that are Black origin and have thinner average central corneal than corneal thickness, there can be under diagnosis of elevated pressure (Watkinson, 2013). A good patient history and physicals should be addressed in all the related questions. In other words subjective and objective data should be collected when assessing patients with glaucoma (Watkinson, 2013).
Patient should be taught to keep regular clinic appointments, monitor vital recognition for any worsening and possible dangers to upcoming sight-related eminence of life. Older adults with reduced vision are at an imminent risk of falls, which results in a deterioration in health status, daily active way of life and quality (James, 2014).
Unfortunately, there is no treatment for patients who have glaucoma. It is irreversible. Patients would only go to procedures to normalize the intraocular pressure in order to avoid additional vision loss. Medications like eye drops are very convenient to lower pressure and during acute time to help with pain, redness, dryness, and inflammation. Advanced treatments are laser surgery and other forms of invasive surgery. Patients would need laboratory work up, and if they have diabetes, blood sugar should be checked. Reduced sensory perception is also associated to damage of peripheral sight (Kahook, 2012).
References
James, B. (2014). Glaucoma. Current Medical Literature, 24(1), 29. Retrieved from: http://southuniversity.summon.serialssolutions.com.southuniversity.libproxy.edmc.edu/se arch?fvf=Language%2CEnglish&q=Chronic+Open- Angle+Glaucoma#!/search?ho=t&fvf=Language,English,f&q=Chronic%20Open- Angle%20Glaucoma&l=en
Kahook, M. Y. (2012). Essentials of glaucoma surgery. Thorofare, New Jersey: SLACK Inc.
Nova Science Publishers, I. (2012). Glaucoma: Etiology, pathogenesis and treatments Nova Science Publishers, Inc.
SATUE, M., HERRERO LATORRE, R., DE LA MATA, G., FERNANDEZ‐PEREZ, S., GARCIA MARTIN, E., & POLO, V. (2011). Closed angle glaucoma and myopia as an adverse effect of topiramate. Acta Ophthalmologica, 89(s248), 0-0. doi:10.1111/j.1755- 3768.2011.226.x
Watkinson, S. (2010). Improving care of chronic open angle glaucoma. Nursing Older People, 22(8), 18.
Watkinson, S. (2013). Assessment and management of patients with acute red eye. Nursing Older People, 25(5), 27.
