Glaucoma

Definition

Glaucoma is a group of progressive optic nerve disorders usually associated with elevated intraocular pressure (IOP > 21 mmHg), causing characteristic visual field loss. Classically starting with peripheral vision.

Types

• Primary open-angle (most common): Gradual, painless peripheral vision loss, 'tunnel vision.'
• Angle-closure (acute): Sudden severe eye pain, headache, blurred vision, halos around lights, nausea/vomiting, fixed mid-dilated pupil. OCULAR EMERGENCY.

Risk Factors

Age ≥ 60, family history, African American or Asian heritage, diabetes, steroid use.

Nursing Considerations

• Open-angle: Lifelong eye drops (prostaglandin analogs, beta-blockers, alpha agonists, carbonic anhydrase inhibitors). Teach punctal occlusion (press inner canthus × 60 seconds) to reduce systemic absorption.
• Angle-closure: IV mannitol, miotics (pilocarpine), iridotomy.
• Avoid anticholinergics (dilate pupils; can trigger angle-closure).

NCLEX Relevance

Peripheral vision loss (tunnel vision) = open-angle. Sudden eye pain with halos = angle-closure emergency.