AKAL COLLEGE OF NURSING, BARU SAHIB

SUBJECT: MEDICAL SURGICAL NURSING

LESSON PLAN
ON
“GLAUCOMA”

SUBMITTED TO: SUBMITTED BY:-

MRS. BABITA KUMARI SMRITI
ASSISTANT PROFESSOR MSc. (N) 1stYear
ACN, BARU SAHIB ACN, BARU SAHIB

SUBMITTED ON- 10th of April, 2024

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 IDENTIFICATION DATA
Name of the student teacher : - Ms. Smriti

Name evaluator : -Mrs. Babita Kumari

Subject : - Medical Surgical Nursing

Topic : -Glaucoma

Date : -10th of April, 2024

Time of teaching : -12pm-1pm

Venue of teaching : -B.Sc.(N) 2nd Year

Language : - English, Hindi

Size of group : -60

Method of teaching : - Lecture cum discussion method

Duration : - 40-45 minutes

AV-Aids : - Power Point Presentation, Chart, Handouts and Green board

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 GENERAL OBJECTIVES: At the end of the teaching the students will be able to know about the glaucoma and will develop a positive
attitude towards the disease condition and their skills will be improved in the clinical settings.

SPECIFIC OBJECTIVES: At the end of the topic the students will be able to:-

 introduce glaucoma.
 define glaucoma.
 explain the incidence of glaucoma.
 explain the etiology of glaucoma.
 explain the pathophysiology of glaucoma.
 classify glaucoma.
 enlist clinical manifestations of glaucoma.
 describe diagnostic evaluation of glaucoma.
 explain medical management of glaucoma.
 explain surgical management of glaucoma.
 explain nursing management of glaucoma.
 enlist complications of glaucoma

S.No. Time Specific Content Teaching AV Aids Evaluation

objective learning
activity

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 1 min To introduce Good morning, my name is Smriti. I am the student of Self-introducing Self-introduced
self
MSc. (N) 1st year in Akal College of Nursing, Baru Sahib
and today I am here to present my topic i.e.
GLAUCOMA

“GLAUCOMA”

2 mins
INTRODUCTION What do you
1.
To introduce GLAUCOMA is optic nerve harm (regularly however not Lecture cum mean by
the topic generally connected with expanded eye pressure) that discussion glaucoma?
prompts moderate irreversible loss of vision. The term method
GLAUCOMA is a term used to refer group of ocular Power point
presentation
condition characterized by the optic nerve damage.
Glaucoma occurs as a result of increased intraocular
pressure (IOP) caused by malformation or malfunction of
the eye drainage system. Normal IOP is 19-21 inches of
mercury. The increased pressure causes compression of
the retina and the optic nerve and causes progressive,
permanent loss of eyesight if left untreated.

To define Define
2. 2 mins
glaucoma glaucoma.
DEFINITION
Power point
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 According to Brunner: - Glaucoma is a group of presentation
disorders characterised by an abnormally high intraocular
pressure, optic nerve dystrophy and peripheral field loss.
OR
According to LP Aggarwal:-Glaucoma is a Lecture cum
symptomatic condition of the eye where the intraocular discussion
What is the
pressure is more than normal. method
To explain incidence of
3. Power point
INCIDENCE presentation glaucoma?
2 mins the incidence
of glaucoma Just approximately three million people with inside the
US and 14 million people international have glaucoma.
Glaucoma is the 1/3 using purpose for visible deficiency
international.
More common in people older than 40 years. What are the

4. To explain ETIOLOGY causes of

5 mins Handouts glaucoma?
the causes of 1. GENETICS: - Family history of glaucoma.
glaucoma 2. AGEING
3. OCULAR HYPERTENSION: - It is a condition
where the pressure in your eyes or IOP is too high
continually high pressure within the eye can
eventually damage the optic nerve and lead to

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 glaucoma or permanent vision loss.
4. SEVERE MYOPIA: - It is associated with an
increased risk of pathological ocular
complications and lead to blinding disorders like
glaucoma.
5. EYE TRAUMA: - It is most commonly caused by
blunt trauma, which is an injury that doesn’t
penetrate the eye, such as blow to the head or an Power point
Lecture cum
injury directly on the eye. This can lead to an discussion presentation
method
increase in eye pressure, which can damage the
optic nerve.
6. OCULAR SURGERY: - Can cause a change in
the eye’s pressure. Sharp increases in eye pressure
are called “Pressure Spikes” and sometimes occur
in patients after cataract surgery.
7. MIGRAINE: - Prolonged increased pressure can
lead to visual loss if not corrected.
8. PROLONGED USE OF LOCAL OR SYSTEMIC
CORTICOSTERIODS: - Long-term use of topical
and systemic steroids produces secondary open
angle glaucoma similar to chronic simple
glaucoma. The increased intraocular pressure

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 caused by prolonged steroid therapy is reversible
but the damage produced by it is irreversible.
9. DIABETES MELLITUS: - Diabetes can lead to
blood vessel development in the drainage angle of
the eye. This can raise eye pressure and cause
glaucoma. The optic nerve gets damaged and
peripheral vision is lost.
To explain 10. OPTIC NERVE DYSTROPHY Chart Explain the
Lecture cum
5. 3 mins the PATHOPHYSIOLOGY pathophysiology
discussion
pathophysiol of glaucoma.
Due to any etiological factors method
ogy of
glaucoma
Increased intra cranial pressure (IOP)

Ischemia of nerves

Damage to optic nerve and result to loss of vision

To explain Classify
the glaucoma.
CLASSIFICATION OF
10 mins classification
6.
of glaucoma

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 GLAUCOMA
Glaucoma is classified into two categories:-
1. Congenital glaucoma
2. Acquired glaucoma
 Primary glaucoma
 Secondary glaucoma Power point
CONGENITAL GLAUCOMA:- presentation

It is a rare disease condition, occurs when a congenital

defect in the angle of the anterior chamber obstructs the Lecture cum
outflow of aqueous humour. If remains untreated causes discussion
damage to optic nerve damage and blindness. method
ACQUIRED GLAUCOMA:-
PRIMARY GLAUCOMA:- Primary glaucoma is a
progressive condition and is most common cause of
irreversible blindness across worldwide.
It is of two types :-
1. Primary angle closure glaucoma
2. Primary open angle glaucoma
 PRIMARY OPEN ANGLE
GLAUCOMA:- It results from the
overproduction of aqueous humour through

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 trabecular meshwork results in increased IOP and
damage to optic nerve and results in loss of vision
and also called as chronic simple glaucoma or
simple complex glaucoma.

 PRIMARY ANGLE CLOSURE

GLAUCOMA: - It is also called as primary Power point
closed angle glaucoma, narrow angle glaucoma, presentation

pupil block glaucoma and acute congestive

glaucoma. This is due to the abnormality of
structure in front of the eyes. This result from the Lecture cum

obstruction to the outflow of aqueous humour. discussion

SECONDARY GLAUCOMA:- method

Secondary glaucoma occurs as a result of either diseases

within the eyes such as uveitis, inflammation, trauma,
intraocular haemorrhage, previous surgeries, diabetes and
steroid medication, etc.
LENS INDUCED GLAUCOMA:-
 It occurs due to trabecular blockage
 It occurs due to clogging of trabecular by
inflammatory material
GLAUCOMA DUE TO UVEITIS:-

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  IOP is raised due to clogging by inflammatory
material and associate trabeculitis.
NEUROVASCULAR GLAUCOMA:-
 Uncommon type of glaucoma Power point
 Difficult to treat presentation

 Caused by proliferative diabetic retinopathy

GLAUCOMA ASSOCIATED WITH INTRAOCULAR
TUMOR:-
 Intraocular tumour such as retinoblastoma and
malignant melanoma may rise IOP.
STEROID INDUCED GLAUCOMA:- Lecture cum
 It developed due to sensitivity to steroid. Sudden discussion
rise in IOP may occur, this can be prevented by method
judicious use of steroid.

CLINICAL MANIFESTATIONS
To explain
PRIMARY OPEN ANGLE GLAUCOMA:-
the clinical Explain sign and
 Mild ache in the eyes
manifestation symptoms of the
7. 5 mins  Headache
of glaucoma glaucoma.
 Increased IOP ( more than 24mm/hg )
 Loss of peripheral vision

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  Reduced visual acuity at night
 Corneal edema
 Visual field deficit
PRIMARY ANGLE CLOSURE GLAUCOMA:- Power point
presentation
 Pain and redness in eyes
 Increased IOP
 Blurred vision
 Headache
 Nausea
 Vomiting
 Oedematous cornea
Lecture cum
 Decreased acuity
discussion
 Moderate pupillary dilation
method

DIAGNOSTIC EVALUATION
To explain How will you
the diagnostic 1. History collection diagnose the
evaluation of 2. Patient ocular and medical history glaucoma?
glaucoma 3. Tonometry (to measure IOP)
8. 5 mins
4. Ophthalmoscopy (to show the cupping of the optic
disc)

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 5. Genioscopy (to determine the angle of the eyes
anterior chamber)
6. Perimetery or visual field test (to detect loss of
peripheral vision)
7. Slit lamp examination
8. Fundus photography Power point
presentation
9. Nerve fibre analysis (to assess the thickness of
nerve fibre layer)
10. Pachymetery (it measures corneal thickness)

MANAGEMENT How will you do

To explain the management
GOAL OF MANAGEMENT MEASURE Lecture cum
the of glaucoma?
INCLUDES:- discussion
management
 To reduce IOP method
of glaucoma
10 mins
 To prevent the damage of optic nerve
9.
Management measures mainly include:-
 Medical management
 Surgical management
 Nursing management
MEDICAL MANAGEMENT:-
1. Beta adrenergic blockers:- Decreases aqueous
humour production for example:- Timolol,

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 Betaxolol.
2. Colinergics (Miotics):- Reduces IOP by
facilitating the outflow of aqueous humour. For
example:- Pilocarpine, Carbocol
3. Carbonic anhydrase inhibitor:- Decrease the Power point
formation and secretion of aqueous humour. presentation

4. Prostaglandins analogs:- Reduces IOP by

increasing uveoscleral flow.
5. Osmotic agents:- IV mannitol 20% or oral
glycerine 50% is used to reduce IOP by creating
Lecture cum
an osmotic pressure between blood and
discussion
intraocular fluid.
method
SURGICAL MANAGEMENT :-
ARGON LASER TRABECULOPLASTY:-
 It is used to treat open angle glaucoma
 Thermal argon laser burns are applied to the inner
surface to trabecular meshwork to open intra
trabecular meshwork to open intra trabecular
space, thus reduces outflow of aqueous humour
and decreased IOP.
LASER IRIDOTOMY:-

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  In this surgical procedure, an opening is made by
the laser beam in the iris to eliminate pupillary
block.
Power point
 Relieve the pressure and preserve the vision by presentation
promoting outflow of the aqueous humour.
CYCLOCRYOTHERAPY:-
Application of a freezing probe to the sclera over the
ciliary body that destroy some of the ciliary processes,
results in the reduction of the amount of the aqueous
humour. Lecture cum
CYCLODIALYSIS:- discussion
Through a small incision in the sclera a spatula type method
instrument is passed into the anterior chamber, creating
an opening in the angle.
FILTERING PROCEDURE:-
For chronic glaucoma filtering procedure are used to
create an opening or fistula in the trabecular meshwork to
drain aqueous humour. This allows the aqueous humour
to flow and exist different route.
TRABECULOTOMY:-
In this procedure a partial thickness incision is made in
the sclera. Section of sclera is removed to procedure an

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opening for outflow of aqueous humour.
DRAINAGE IMPLANTS AND SHUNTS:-
It is used to shunt the aqueous humour in the conjunctival
space. Implants and shunts are the open tubes implanted Power point
in the anterior chamber through sclerotomy. presentation

NURSING MANAGEMENT:-
 History collection (Positive family history).
 Eye contusion from trauma.
 Intra ocular haemorrhage.
 Assess for sudden severe pain in eyes, halo light,
blurred vision, etc.
 Check for diagnostic measures. Lecture cum

 Assess the patient understanding and emotional discussion

response to the condition. method

 Monitor vital signs of the patient.

 Monitor the degree of eye pain very 30 min during
the acute phase.
 Monitor visual acuity at any time before hatching
ophthalmic agent for glaucoma.
 Maintain the bed rest in semi-fowler position.
 Give analgesics prescription and evaluation of its

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 effectiveness.
RESEARCH ARTICLE:-
The diagnosis and treatment of glaucoma
The Diagnosis and Treatment of Glaucoma
Lecture cum
In this article, we present the epidemiology of and risk Power point
discussion presentation
factors for glaucoma, as well as the diagnostic work-up
method
and treatment options.
In Europe, the prevalence of glaucoma is 2.93% among
persons aged 40 to 80 years. The prevalence rises with
age, reaching 10% in persons over 90 years old. The
10.
available diagnostic methods include ophthalmoscopy,
tonometry, perimetry, and imaging techniques. The
treatment of glaucoma is focused on lowering the
intraocular pressure with topical drugs, laser therapy, and
glaucoma surgery. In patients with manifest glaucoma,
lowering the intraocular pressure prevents the progression
of visual field defects, with a number needed to treat of 7.
The diagnostic evaluation of glaucoma rests on multiple
pillars, all of which must be considered for establishing
the diagnosis and defining the desired target pressure:
these are, among others, the intraocular pressure and

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 ocular function and morphology. Individually tailored
pressure-lowering treatment should be evaluated in
regularly scheduled follow-up visits for assessment of
function and morphology and adjusted as necessary to
minimize the risk of progression.

CONCLUSION:-
Glaucoma is a common eye disease that is usually
associated with elevated intraocular pressure. Glaucoma
can occur for a number of many reasons. Most cases are
caused by a build-up pressure in the eye when fluid is
enable to drain properly.
SUMMARY:-
To conclude Glaucoma is a group of eye disorders that can cause Concluded
the topic vision loss and blindness by damaging a nerve in the back
of your eye called optic nerve. The symptoms can start so
11. 2 mins slowly that you may not notice them.

Concluding
To Summarised
summarize
the topic

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12. 2 mins

Summarizing

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 BIBLIOGRAPHY:-
BOOK REFERENCES:-
 Williams. L, Wilkins. Lippincott manual of nursing
practice. 9th Edition. Wolters Kluwer Publishers;
2010, 1558-1561.
 Suddarth’s and Brunner, Textbook of Medical and
surgical nursing. 2nd Edition. Wolters Kluwer
Publishers; 2022, 1673-1682
 Chintamani. Lewis’s Medical Surgical Nursing.
7thed. New Delhi: Elsevier limited; 2010.
 Smeltzer CS. Bare B. Brunner & Suddarth’s
Textbook of Medical Surgical Nursing. 10 th ed.
Philadelphia (PA): Lippincott Publishers; 2006
 Brunner & Suddhart’s. “Textbook of medical-
surgical nursing”. 11th edition.Elsevier publishers.

INTERNET REFERENCES:-
Neha bharti; available from:-
https://www.slideshare.net/tanukatnawer9/glaucoma-
120786570

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