Types
Open-angle (most common, 90%): gradual IOP increase, painless, peripheral vision loss first. Angle-closure (acute): sudden IOP increase, severe eye pain, nausea/vomiting, halos, red eye, fixed pupil — emergency. Normal-tension: optic nerve damage despite normal IOP.
Treatment
Open-angle: topical beta-blockers (timolol), prostaglandin analogs (latanoprost), alpha-2 agonists (brimonidine), carbonic anhydrase inhibitors (dorzolamide). Surgery: laser trabeculoplasty, trabeculectomy. Angle-closure: emergency — IV mannitol, pilocarpine, peripheral iridotomy. Adherence critical — vision loss is irreversible.
Nursing Care
Medication education: instill drops correctly, do not touch tip to eye, wait 5 min between different drops. Monitor side effects: beta-blockers (bradycardia, bronchospasm). Report: eye pain, vision changes, halos, nausea/vomiting. Regular IOP monitoring. Fall prevention (impaired peripheral vision).
Important Notes
- Acute angle-closure glaucoma is an ophthalmologic emergency — sudden severe eye pain, halos, fixed pupil, nausea/vomiting.
- Glaucoma medications must be instilled consistently — missed doses lead to irreversible vision loss.
Clinical Tips
- Beta-blocker eye drops (timolol) can cause systemic effects: bradycardia, bronchospasm — caution in asthma/COPD.
- Apply gentle pressure to nasolacrimal duct for 1 minute after drops — reduces systemic absorption.
Summary
Glaucoma management requires lifelong IOP-lowering medications, adherence education, side effect monitoring, and emergency recognition of acute angle-closure.
