Community, unless sudden increase in IOP requires emergency intervention and close monitoring.
- Psychosocial aspects of care
- Patient Assessment Database
Change in usual activities/hobbies due to altered vision
Nausea/vomiting (acute glaucoma)
- Gradual loss of peripheral vision, frequent change of glasses, difficulty adjusting to darkened room, halos around lights, mild headache (chronic glaucoma)
- Cloudy/blurred vision, appearance of halos/rainbows around lights, sudden loss of peripheral vision, photophobia (acute glaucoma)
- Glasses/treatment change does not improve vision
- Dilated, fixed, cloudy pupils (acute glaucoma)
- Fixed pupil and red/hard eye with cloudy cornea (glaucoma emergency)
- Increased tearing
- Intumescent cataracts, intraocular hemorrhage (glaucoma secondary to trauma)
- Mild discomfort or aching/tired eyes (chronic glaucoma)
- Sudden/persistent severe pain or pressure in and around eye(s), headache (acute glaucoma)
- History of hemorrhage, trauma, ocular disease, tumor (secondary to trauma)
- Difficulty seeing, managing activities
Inflammatory disease of eye (glaucoma secondary to trauma)
- Family history of glaucoma, diabetes, systemic vascular disorders
- History of stress, allergies, vasomotor disturbances (e.g., increased venous pressure), endocrine imbalance, diabetes
- History of ocular surgery/cataract removal; steroid use
- Discharge plan
- May require assistance with transportation, meal preparation, self-care, homemaker/ maintenance tasks
- Refer to section at end of plan for postdischarge considerations.
- Ophthalmoscopy examination: Assesses internal ocular structures, noting optic disc atrophy, papilledema, retinal hemorrhage, and microaneurysms. Slit-lamp examination provides three-dimensional view of eye structures, identifies corneal abnormalities/change in shape, increased IOP, and general vision deficits associated with glaucoma.
- Visual acuity tests (e.g., Snellen, Jayer): Vision may be impaired by defects in cornea, lens, aqueous or vitreous humor, refraction, or disease of the nervous or vascular system supplying the retina or optic pathway.
- Visual fields (e.g., confrontation, tangent screen, perimetry): Reduction of peripheral vision may be caused by glaucoma or other conditions such as cerebrovascular accident (CVA), pituitary/brain tumor mass, or carotid or cerebral artery pathology.
- Tonography measurement: Assesses intraocular pressure (normal: 12–20 mm Hg). In acute angle-closure glaucoma,
- IOP may be 50 mm Hg or higher.
- Gonioscopy measurement: Helps differentiate open-angle from angle-closure glaucoma.
- Provocative tests: May be useful in establishing presence/type of glaucoma when IOP is normal or only mildly elevated.
- Glucose tolerance test/fasting blood sugar (FBS): Determines presence/control of diabetes, which is implicated at times in secondary glaucoma.
- Prevent further visual deterioration.
- Promote adaptation to changes in/reduced visual acuity.
- Prevent complications.
- Provide information about disease process/prognosis and treatment needs.
- Vision maintained at highest possible level.
- Patient coping with situation in a positive manner.
- Complications prevented/minimized.
- Disease process/prognosis and therapeutic regimen understood.
- Plan in place to meet needs after discharge.