Faculty of nursing

Technical institute of nursing

Geriatric nursing area

Glaucoma

Prepared by :
Second year students
Group B5
Under supervision of:
Dr. Hewida Mostafa
Academic year:
2025 - 2026

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​ NO ​ NAME ​ ID
1 Zeyad Khaled Fathy Ashour 309
2 Zeyad Rizk Mohamed Alhendawy 310
3 Zeyad Samir Abdelmaqsuod Mahmoud 311
4 Zeyad Tarek Abdelrazek Mohamed 312
5 Zeyad Mohamed Alsaeed Mohamed 313
6 Zeyad Mohamed Saeed Mahmoud 314
7 Zeyad Mohamed Sabra Abdullah 315
8 Zeyad Mohamed Abdelrahman Bayoumi 316
9 Zeyad Mohamed Fouad Adlan 317
10 Zeyad Yasser Ibrahim Mohamed 318
11 Zaynab Elsayed Nasr Mahmoud 319
12 Zeina Ahmed Ramadan Khamis 320
13 Sara Ahmed Ibrahim Elsayed 321
14 Sara Ahmed Raafat Mohamed 322
15 Sara Ayman Abdelmoaty Mohamed 323
16 Sara Galal Abdelsalam Alshabrawy 324
17 Sara Gamal Abdelaziz Ibrahim 325
18 Sara Khaled Reyad Amer 326
19 Sara Asem Hoseeny Alhendawy 327
20 Sara Atef Ali Tawfik 328
21 Sara Abdelrady Badr Abdelbar 329
22 Sara Ali Gaber Aboeita 330

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Objectives:

★To define glaucoma and explain its pathophysiology.

★To identify the different types of glaucoma, including primary open-angle

glaucoma, angle-closure glaucoma, congenital glaucoma, and secondary glaucoma.

★To describe the risk factors associated with glaucoma development.

★To explain the clinical manifestations and symptoms of glaucoma.

★To discuss the diagnostic methods used for early detection, including
measurement of intraocular pressure (IOP), visual field testing, and optic nerve
assessment.

★To outline the medical and surgical management options available for glaucoma
treatment.

★To highlight the importance of early diagnosis and regular follow-up in preventing
vision loss.

★To explore nursing management and patient education strategies for improving
treatment adherence and outcomes.

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Outlines:

•​ Objectives
•​ Introduction
•​ Definition
•​ Causes
•​ Risk factors
•​ Signs and symptoms
•​ Stages
•​ Classifications
•​ Types
•​ Investigations
•​ Complications
•​ Treatment
•​ Nursing interventions
•​ Prevention
•​ Abbreviations
•​ References

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Introduction:
What is Glaucoma?
Glaucoma is a group of eye diseases that can cause vision loss and blindness by
damaging a nerve in the back of your eye called the optic nerve.

The symptoms can start so slowly that you may not notice them. The only way to
find out if you have glaucoma is to get a comprehensive dilated eye exam.

There’s no cure for glaucoma, but early treatment can often stop the damage and
protect your vision.
​

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Definition:
Glaucoma is a group of eye conditions that damage the optic nerve, the health of
which is vital for good vision.
This damage is often caused by an abnormally high pressure in the eye. If this
condition is left untreated it can lead to blindness.
Glaucoma patients sometimes see blue spots around sources of light, and this is how
the name came to be; the word glaucoma came from ancient Greek, meaning
clouded or blue-green hue

Causes:

1. Increased Intraocular Pressure (IOP)

-​Blockage of trabecular meshwork (drainage system)
-​Excessive production of aqueous humor

2. Types-specific causes
-​ Open-angle:
Gradual blockage of trabecular meshwork (most common type, often with
elevated IOP)
-​ Angle-closure:
Sudden blockage of drainage angle (medical emergency)
-​ Normal-tension:
Poor blood flow to the optic nerve (vascular factors)
-​ Genetic predisposition:
Increased susceptibility of the optic nerve

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 Possible issues with CSF dynamics around the optic nerve
-​ Secondary glaucoma: caused by other conditions (uveitis, tumors,
injuries)Elevated IOP is a major factor in most glaucoma types, but damage
can occur even with normal pressure.

Risk factors:

●​ Age : Most types of glaucoma affect people age 40 and older (congenital
types are the biggest exception to this). Experts estimate that 10% of people
age 75 and older have glaucoma.

●​ Race : Black people have a much higher risk of developing primary

openangle glaucoma, especially people of Afro-Caribbean descent. People of
African descent are 15 times more likely to have blindness from openangle
glaucoma. People of Asian and Inuit descent have a higher risk of
angle-closure glaucoma.

●​ Sex : Women have a higher risk of angle-closure glaucoma. Experts suspect

this is mainly because of sex-linked differences in eye anatomy.

●​ Refractive errors : People with nearsightedness (myopia) have a higher risk

of open-angle glaucoma. People with farsightedness (hyperopia) have a
higher risk of angle-closure glaucoma.

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 ●​ Family history : There’s evidence that a family history of glaucoma,
especially a first-degree biological relative (a parent, child or sibling), means
you also have a higher risk of developing it. And several conditions that
cause secondary glaucoma are genetic, too.

●​ Chronic conditions : like high blood pressure (hypertension) and diabetes, to

much higher odds of developing glaucoma.

Signs and symptoms:

Patients rarely notice glaucoma signs and symptoms until it is too late. Two
main types of glaucoma exist:

1- Primary open-angle glaucoma symptoms:

•​Primary open-angle glaucoma is the most common type of glaucoma.
•​The condition develops slowly, and few obvious symptoms occur at its earliest
stages
Gradually , patchy blind spots in your side vision ( peripheral vision )
• In late stages: Difficulty seeing things in your central vision

2- Acute angle closure glaucoma :

•​It is an emergency
•​Symptoms may come and go at first, or steadily become worse Symptoms and
signs include:
-​Bad headache

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-​sever eye pain
-​Nausea or vomiting
-​Blurred vision
-​Halos or colored rings around lights
-​Eye redness

Stages:

1. Early / Mild Stage

This is the "silent" phase where damage begins but remains largely invisible to the
patient.
Condition: Initial damage to the optic nerve fibers often caused by high intraocular
pressure (IOP).
Symptoms: Typically asymptomatic (no pain or noticeable vision loss).
Vision: Subtle changes in peripheral vision that are often unnoticed. Regular eye
exams are the only way to detect glaucoma at this stage.

2. Moderate Stage
As the disease progresses, the damage to the optic nerve becomes clinically evident.
Condition: Increased IOP leads to irreversible but treatable nerve erosion.
Symptoms: Difficulty adjusting to low-light environments and occasional
blurred vision.
Vision: Clear blind spots begin to form in the visual field. Peripheral vision loss
starts becoming noticeable, making it harder to see objects or movement on the
sides.

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3. Advanced Stage
At this stage, the vision loss significantly impacts the patient’s quality of life.
Condition: Severe optic nerve damage. The risk of accidents or falls increases
significantly due to limited spatial awareness.
Symptoms: Distorted vision and, in some specific types of glaucoma, severe eye
pain.
Vision: Development of Tunnel Vision (central vision remains intact, but the outer
field is lost). Daily activities like driving or walking in crowded spaces become
challenging.

4. End-Stage / Severe Stage

This is the final phase characterized by extensive neurological damage.
Condition: Extensive and permanent damage to the optic nerve, leading to a loss of
independence.
Symptoms: Persistent eye discomfort or pain and significant functional impairment.
Vision: Severe vision loss or total blindness. Any remaining vision is very limited,
and the damage is permanent.

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Classifications:

1- Primary Glaucoma (Adult-Onset)

Primary Open-Angle (POAG): Open angle on gonioscopy; progressive neuropathy
with no secondary cause. (Most common).
Primary Angle-Closure (PACG): Aqueous outflow obstruction due to angle closure;
associated with shallow anterior chambers.

2- Secondary Glaucoma
Secondary Open-Angle: Caused by specific factors like steroids, uveitis, pigmentary,
or pseudoexfoliative changes.
Secondary Angle-Closure: Caused by structural shifts such as neovascularization,
lens-induced issues, tumors, or trauma.

3- Childhood Glaucoma
I- Primary
Primary Congenital (PCG): Isolated developmental angle anomaly; often presents
with buphthalmos. Classified by age: Neonatal, Infantile, or Late-onset. Juvenile
Open-Angle (JOAG): Onset after early childhood; open angle with no ocular
enlargement.

II- Secondary
Associated with Ocular Anomalies: (e.g., Aniridia, Axenfeld-Rieger).
Associated with Systemic Diseases: (e.g., Sturge-Weber, Neurofibromatosis).
Acquired Conditions: Resulting from trauma, uveitis, or tumors.
Following Cataract Surgery (GFCS): Develops after pediatric cataract extraction.

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Types:

•​Primary open-angle glaucoma is the most common form.

The channels that drain fluid from the eyes become clogged, causing an increase in
pressure. A person may have few warning signs, but if caught early, this form of
glaucoma generally responds well to medication.

•​Acute angle-closure glaucoma often occurs in people with smaller eyes, where
blockages are more likely. It causes sudden, intense symptoms that require urgent
treatment: medication to lower the pressure is usually needed before surgery can be
carried out to correct the issue.

•​Secondary glaucoma is usually caused by an injury to the eye, illness or taking

certain types of medication, such as steroids.

Investigations:
1. Functional Assessment (Visual Field Testing)
Standard Automated Perimetry (SAP) is the gold standard for measuring what the
patient sees and monitoring disease progression.
Gold Standard: Humphrey Field Analyzer (HFA) using the 24-2 test pattern and
Goldmann size III stimulus.
Algorithms: SITA Standard or SITA Fast are used to optimize reliability and testing
time.
Mean Deviation (MD): A summary measure of total VF loss expressed in
decibels (dB). More negative values indicate greater damage. Testing
Frequency: For new patients, 6 VF tests in the first 2 years are recommended
to accurately calculate the Rate of Progression (RoP).

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2. Structural Assessment (Optic Nerve & Retina)
These tests detect physical changes in the eye’s anatomy, often before vision loss
occurs.
Optical Coherence Tomography (OCT): Measures the Retinal Nerve Fiber
Layer (RNFL) thickness. This is vital for detecting "Pre-perimetric Glaucoma."
Optic Nerve Head (ONH) Imaging: Clinical documentation of the Cup-to-Disc Ratio
(CDR) and monitoring for "Notching" or "Drance Hemorrhages" (splinter
hemorrhages).
Longitudinal Analysis: Uses regression models (like OLSLR or Tobit) to track
thinning of the nerve tissue over time.

3. Physiological & Clinical Measures

Essential for determining the type of glaucoma and the accuracy of pressure
readings.
Goldmann Applanation Tonometry (GAT): The international gold standard for
measuring Intraocular Pressure (IOP).
Gonioscopy: A mandatory clinical investigation to visualize the drainage angle and
differentiate between Open-Angle and Angle-Closure glaucoma. Pachymetry (CCT):
Measures Central Corneal Thickness. Since corneal thickness affects IOP readings,
this is crucial for clinical accuracy.

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4. Progression Staging (Bascom Palmer System)
Cases are staged based on the severity of the Mean Deviation (MD) from SAP:
Mild: MD > -6 dB
Moderate: MD -6 dB to -12 dB
Severe: MD -12 dB to -20 dB
Visually Impaired: MD < -20 dB (End-stage)

Complications:
1- Optic Nerve Damage
This is the main complication of glaucoma. Increased eye pressure gradually
damages the optic nerve fibers.
The damage is permanent and cannot be reversed.
Patients may lose the ability to see clearly as the disease progresses.

2- Peripheral Vision Loss

Glaucoma usually affects side vision first.
Central vision may remain normal at first, making it hard to notice early changes.
Over time, the visual field becomes narrower, creating “tunnel vision.”

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3- Visual Field Defects
Blind spots (scotomas) appear in different areas of vision.
These defects grow larger as glaucoma advances.
This makes activities like reading, driving, or walking more difficult.

4- Complete Blindness
If glaucoma is untreated or poorly managed, it can lead to total and irreversible
vision loss.
This is why glaucoma is a leading cause of permanent blindness worldwide.

5- Visual Disturbances
Some patients see halos around lights, blurred vision, or have trouble seeing at night.
These effects usually happen in advanced stages or in acute glaucoma attacks.

6- Complete and Permanent Blindness

If glaucoma is untreated or poorly controlled, it may cause total irreversible
blindness.
This is one of the leading causes of preventable blindness worldwide.

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Treatment:

1- Eye Drops
Eye drops are the most common form of treatment for glaucoma. If you’ve been
prescribed eye drops it is very important that you continue to use them exactly as
prescribed.

2- Oral Medications
Oral Medication may be used to treat open-angle glaucoma. This medication is
usually used only for a short period because its effectiveness can reduce over time
and it often has some side-effects.

3- Laser Treatment
Different lasers are used to treat open and closed angle glaucoma. Laser can be
applied to the iris or the trabecular meshwork to allow aqueous fluid to flow more
effectively within the eye, and drain better by the normal drainage channels within
the eye.
Selective Laser Trabeculoplasty (SLT)
Laser Peripheral Iridotomy (LPI)
Cyclodiode Laser Treatment
Argon Laser Treatment

4- MIGS
In recent years, a new class of treatment called ‘minimally invasive glaucoma
surgery’ or ‘MIGS’ is changing the glaucoma treatment model. These procedures
use tiny incisions to place microscopic devices inside the eye to lower the pressure
inside the eye.
Internal Stent Inject
Internal Stent Infinite
Hydrus XEN Gel
Stent
Internal Track - Ab-Interno Canaloplasty

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5- Conventional Surgery
Surgery may sometimes be required if the disease cannot be controlled using
medications or laser, or the patient is intolerant of the above strategies. The
requirement for surgery becomes more urgent the more aggressive or advanced
glaucoma becomes.
Trabeculectomy
Glaucoma Drainage Devices (GDD)

Nursing interventions:

★Pre-Operative Care
●(Day Before Surgery)
Personal Preparation and Diet
Explain the surgical steps in simple terms, provide support and reassurance to reduce
anxiety.
Eat a light dinner the night before surgery.
Complete fasting from midnight until after surgery.
Shower thoroughly and avoid applying any eye makeup on the day of surgery.

●(Day of Surgery)
1- Preparing the Operating Room and Instruments
• Ensure the operating room is fully sterilized.
• Set surgical lighting and surgical microscope properly.
• Prepare all ophthalmic surgical instruments on a sterile instrument tray.

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2- Patient Assessment
• Check vital signs to ensure stability (blood pressure, heart rate, blood sugar).
• Assess visual acuity and measure intraocular pressure (IOP).
• Review the patient’s medical history and allergies.

3- Medication Preparation
• Administer prescribed eye drops before surgery.
• Give the patient the usual blood pressure and heart medications with a very small sip
of water.
• Avoid diabetes medications, aspirin, and blood thinners if the patient usually takes
them.
• Glaucoma medication: Do not put glaucoma drops in the eye to be operated on, but
continue using them in the other eye as usual.

★During Operative Care Include:

•​Barraquer Wire Speculum & Solid Blade Speculum
•​Westcott Tenotomy Scissors & Vannas Scissors
•​Colibri Forceps & Tying Forceps (McPherson) & Toothed Tissue Forceps
•​Castroviejo Needle Holder
•​Castroviejo Calipers & Muscle Hooks
•​Scleral Depressor / Probe
•​Cautery Tool (Handheld)

★ Role of the Scrub Nurse

☆Before operation
1- Prepare sterile instruments and surgical trays.
2- Ensure proper sterilization of all equipment.
3- Arrange instruments according to surgical steps.
4- Perform surgical hand scrub and wear sterile gown and gloves.
5- Assist in preparing the sterile field.

☆During operation
1- Maintain sterility of the surgical field.
2- Pass instruments to the surgeon accurately and quickly.
3- Anticipate surgeon’s needs during the procedure.
4- Count instruments, needles, and gauze.
5- Handle specimens and send them properly if needed.

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☆After operation
1- Recount instruments and materials.
2- Assist in wound dressing.
3- Remove and organize instruments for sterilization.
4- Document surgical procedures and used materials.

★Role of the Circulating Nurse

☆Before operation
1- Prepare the operating room environment.
2- Check surgical equipment and machines.
3- Verify patient identity and surgical procedure.
4- Assist patient positioning safely (especially important in elderly).

☆During operation
1- Provide additional instruments when needed.
2- Monitor patient’s condition and vital signs.
3- Maintain documentation.
4- Ensure safety measures and infection control.

☆After operation
1- Assist in transferring the patient to recovery room.
2- Document operative details.
3- Ensure operating room cleaning and preparation for next case.

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Post-operative Care
1- Protect the eye: Pad the operated eye until the next day or use a perforated eye
shield.
2- Maintain hygiene and prevent infection: Keep the face clean, avoid touching the
eye, and use prescribed antibiotic drops.
3- Reduce inflammation: Use anti-inflammatory drops for post-operative redness
and swelling.
4- Control pain: Manage mild pain with analgesics like acetaminophen.
5- Recognize warning signs: Sudden severe eye pain or rapid vision loss requires
immediate medical attention.
6- Documentation and reporting: Record all findings, including IOP and eye
appearance, and report abnormalities immediately.

Prevention:

•Glaucoma is a chronic eye disease that can lead to irreversible blindness if not
detected early. Although it cannot always be prevented, its progression can be
reduced through the following preventive measures:

1- Regular Eye Examination

Early detection is the most important preventive step.
People over 40 years, diabetics, and those with a family history of glaucoma should
have regular eye check-ups.
Measurement of intraocular pressure (IOP) helps in
early diagnosis.

2- Control of Risk Factors

Good control of chronic diseases such as diabetes
and hypertension.
Avoid long-term use of corticosteroids without
medical supervision.

3- Healthy Lifestyle
Regular physical activity helps reduce eye pressure.
Eating a healthy diet rich in vitamins A, C, E and omega-3 supports eye health.
Avoid smoking.

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4- Eye Protection
Protect eyes from injuries by wearing protective eyewear during work or sports.
Eye trauma may increase the risk of secondary glaucoma.

5- Medication Compliance
Patients diagnosed with glaucoma should strictly adhere to prescribed eye drops and
treatment plans.
Skipping medications may increase intraocular pressure and worsen the disease.

6- Patient Education
Raising awareness about symptoms such as blurred vision, eye pain, halos around
lights, and headache.
Encourage patients to seek medical care immediately if symptoms appear.

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Abbreviations:
● IOP – Intraocular Pressure
● CSF – Cerebrospinal Fluid
● POAG – Primary Open-Angle Glaucoma
● PACG – Primary Angle-Closure Glaucoma
● PCG – Primary Congenital Glaucoma
● JOAG – Juvenile Open-Angle Glaucoma
● GFCS – Glaucoma Following Cataract Surgery
● SAP – Standard Automated Perimetry
● HFA – Humphrey Field Analyzer
● SITA – Swedish Interactive Threshold Algorithm
● MD – Mean Deviation
● VF – Visual Field
● ROP – Rate of Progression
● OCT – Optical Coherence Tomography
● RNFL – Retinal Nerve Fiber Layer
● ONH – Optic Nerve Head
● CDR – Cup-to-Disc Ratio
● OLSLR – Ordinary Least Squares Linear Regression
● GAT – Goldmann Applanation Tonometry
● CCT – Central Corneal Thickness
● MIGS – Minimally Invasive Glaucoma Surgery
● GDD – Glaucoma Drainage Devices

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References:
1-​ [Link]
[Link]

2-​ National Eye Institute (NEI) . Facts about glaucoma

[Link]
coma

3-​ Healthline - [Link]

4-​ The Lighthouse for the Blind.

[Link]
/

5-​ World Health Organization ( WHO ) .

Blindness and visual impairment.
[Link]

6-​ Mayo Clinic. Glaucoma - symptoms and causes

[Link]
72839

7-​ Centers for Disease Control and Prevention ( CDC ) . Glaucoma

[Link]

8-​ [Link]

9-​ [Link]

10-​[Link]

11-​[Link]

12-​[Link]

13-​[Link]

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14-​[Link]
conditions/glaucoma/?gad_source=1&gad_campaignid=820734673&gbraid=0A
AAAAD8pXDnarkNjAIYGX_sBFKrK0Yaeg

15-​[Link]

16-​[Link]

17-​[Link]

18-​Early symptoms of glaucoma mass General Brigham

[Link]

19-​Glaucoma penn medicine [Link] [Link]

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