Neurological · Topic 4 of 27
Glaucoma (Open-Angle & Angle-Closure)
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Glaucoma (Open-Angle & Angle-Closure)
Raised eye pressure damages the optic nerve, and vision already lost never comes back. Acute angle closure is an emergency.
Why it happens
Raised intraocular pressure (IOP) damages the optic nerve
Who's at risk
Age over 60 and African descent lead the list
What you'll see
Open-angle is silent · angle-closure is sudden and painful
Labs & diagnostics
Normal IOP about 11–21 mmHg
Many nursing texts round the normal range to 10–21 mmHg. In acute angle closure the IOP is usually 40–80 mmHg. People at higher risk need a comprehensive dilated eye exam every 1–2 years; about half of people with glaucoma don't know they have it.
Red flags
Treatment
Iris may darken to brown, possibly permanently
Eyelashes grow longer and darkerCheck the pulse — can slow HR, lower BP, cause bronchospasm
Caution with asthma, COPD or heart blockCan cause drowsiness, fatigue and dry mouth
Not used in children under 2Ask about sulfa allergy
A bitter taste after instilling is commonCheck sulfa allergy; monitor potassium
Tingling hands and feet, kidney stonesHarder to see in dim light
Caution with night driving and poor lightingLaser, surgery and the other eye
Nursing priorities
Open-angle or angle-closure?
Silent and gradual vs sudden and painful
| Open-angle | Angle-closure | |
|---|---|---|
| Onset | Gradual | Sudden — an emergency |
| Pain | Painless | Severe eye pain and headache |
| Vision | Peripheral vision lost first (tunnel vision) | Blurred vision, halos around lights |
| Other signs | Often none until damage is advanced | Nausea, vomiting, red eye, fixed mid-dilated pupil |
| Treatment | Drops for life and regular eye exams | Rapid IOP-lowering drugs, then laser iridotomy |
| Nurse's job | Teach adherence — stopping drops lets silent loss continue | Report immediately |
Teach your patient
Tip off the eye · press the inner corner · wait 5 minutes between drops
Pressing the inner corner (punctal occlusion) limits systemic absorption; some sources allow 3–5 minutes between drops.
Open-angle is silent — painless tunnel vision, drops for life. Angle-closure is sudden — eye pain, halos, vomiting: report now. Vision lost to glaucoma never comes back.
Sources · Overview of Glaucoma (Merck Manual Professional) · Angle-Closure Glaucoma (Merck Manual Professional) · Primary Open-Angle Glaucoma (Merck Manual Professional) · Glaucoma (National Eye Institute) · Medical-Surgical Nursing 18.1 Disorders of the Eye (OpenStax) · Glaucoma (MedlinePlus) · How to Put In Eye Drops (American Academy of Ophthalmology) · Latanoprost Ophthalmic (MedlinePlus) · Dorzolamide and Timolol Ophthalmic (MedlinePlus) · Glaucoma (Merck Manual Consumer) · Acetazolamide Tablets Prescribing Information (FDA) · Follow your facility's protocol for eye drop administration.
Glaucoma (Open-Angle & Angle-Closure)
Glaucoma is damage to the optic nerve, usually from raised intraocular pressure, and the vision it takes cannot be restored, so treatment is lifelong and aims to stop further loss. Normal eye pressure is about 11 to 21 mmHg. Open-angle glaucoma is the silent form: peripheral vision fades gradually and painlessly into tunnel vision, often with no symptoms until the damage is advanced, so the client needs drops for life and regular eye exams even when nothing feels wrong. Acute angle-closure glaucoma is an emergency, with sudden severe eye pain, headache, nausea and vomiting, blurred vision, halos around lights, a red eye and a fixed, mid-dilated pupil, and the nurse reports it immediately. Teaching covers drop technique, including pressing the inner corner of the eye after each drop and waiting at least 5 minutes between different drops. Timolol can slow the pulse and cause bronchospasm, acetazolamide and dorzolamide need a sulfa allergy check, and anticholinergic or dilating drugs are avoided in a client at risk for angle closure.
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