U Assessment

HISTORY. Ask the patient if she or he has had recent eye surgery, trauma, or infection. Use of antihistamines can precipitate closed-angle glaucoma because antihistamines cause pupils to dilate, and this may result in obstruction of fluid flow. Family visual history can help with a diagnosis of chronic open-angle glaucoma. Because open-angle glaucoma develops slowly, the visual history should focus on foggy vision, diminished accommodation, frequent changes in eyeglass prescription, mild eye pain, headache, visual field deficits, and halos around lights.

Gentle palpation of the covered eyeball reveals a firmer globe, which has been caused by the increased IOP. Blind spots and peripheral field losses are confirmed by a visual field examination. Inspect the patient's eyes for reddened sclera, turbid aqueous humor, and moderately dilated non-reactive pupils. Other symptoms include extreme unilateral eye pain, blurred vision, and possibly nausea and vomiting. Symptoms of congenital glaucoma include photophobia, cloudy corneas, excessive tearing, and muscle spasms around the orbital ridge (bleapharospasm).

Validate observations of anxiety, and explore coping strategies to deal with patient concerns. Grieving for the potential of vision loss or vision already lost follows the stages of denial, anger, bargaining, depression, and acceptance.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Normal drainage angle in eye

Elevated: 22-28 mm Hg warning level; >38 mm Hg major concern

Presence of adhesions, aberrant blood vessels, signs of injury

Measures intraocular pressure using a tonometer (instrument that is pressed directly against the anesthetized eye); if a recording device is used (tonography), recorded slope indicates adequacy of drainage

Visualization of entire 360 degrees circumference of iridocorneal angle

Other Tests: Direct opthalmoscopic examination and visual field testing, perimetry, fundus photograph, ultrasound biomicroscopy, and other imaging studies.

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