GLAUCOMA

青光眼

Definition

说明

Glaucoma is a disorder characterized by increased intraocular pressure (IOP) that ultimately damages the optic nerve, leading to visual field loss. Glaucoma may occur congenitally, as a primary disease, or secondary to other ocular or systemic conditions.

青光眼的特征是眼内压增高，最终损坏视神经，导致视野丧失。青光眼可以是先天性的，即原发性青光眼，也可以由其他眼科或系统性疾病引起。

Pathophysiology

病理生理学

Increased IOP results from a decrease in aqueous humor outflow and in some cases may be related to an increase in production of aqueous humor. The outflow of aqueous humor can be decreased by several mechanisms.

眼房水流出减少造成眼内压增高，有的则与房水增多有关。引起房水外流减少的原因有下列几种。

l In open-angle or chronic glaucoma, decreased aqueous outflow is probably caused by increased resistance to outflow in the trabecular meshwork. The increased pressure affects nerve tissue of the optic disc, causing ischemia, and the patient begins to lose peripheral vision.

在开角或慢性青光眼中，房水外流减少很可能是由小梁网外流阻力增加引起的，压力增加影响视神经乳头的神经组织，造成局部缺血，病人渐渐失去周边视觉。

l In closed-angle, or narrow-angle glaucoma, the iridocorneal angle closes, blocking aqueous outflow. This change may occur with normal lens enlargement throughout life and can be acute, subacute, or chronic.

在闭角或狭角性青光眼中，前房角闭合，阻断房水外流。它是由正常晶体增大引起，有急性，有亚急性或慢性。

l In secondary glaucoma, increased IOP results from other ocular or systemic conditions that may block outflow channels in some way such as the inflammatory process.

在继发性青光眼中，某些眼科或系统性疾病造成眼内压增高，某种程度地阻塞了房水外流通道，如炎症等。

Clinical Manifestations

临床表现

l Open-angle (chronic) glaucoma develops slowly with symptoms of pain or pressure, usually noticed when peripheral vision is severely compromised (tunnel vision).

开角（慢性)青光眼发展缓慢，伴有疼痛或压迫感，通常在周边视觉严重受损（视野收缩)时才会注意到。 医学 全在.线提供

l Acute angle-closure glaucoma causes definite symptoms of sudden excruciating pain in or around the eye and can be accompanied by nausea and vomiting. Visual symptoms include seeing colored halos around lights, blurred vision, and ocular redness.

急性闭角型青光眼的明显症状为眼内或眼睛周围突然极痛，并伴有恶心和呕吐。视觉症状包括看灯光时出现色圈、视力模糊及眼睛红肿。

The acute pressure rise may also cause corneal edema, giving the cornea a steamy appearance.

眼压急性升高也可以引起角膜水肿，使角膜呈现出篜汽样外观。

l Manifestations of subacute or chronic angle-closure glaucoma appear gradually. The patient who has had a previously unrecognized episode of subacute angle-closure glaucoma may report a history of blurred vision, colored halos around lights, ocular redness, or eye or brow pain.

亚急性或慢性闭角性青光眼症状出现缓慢，有未确认性亚急性闭角青光眼发作史的病人通常会有视力模糊、灯光色圈、眼睛红肿，或眼睛、眉毛　疼痛等。

Diagnostic Studies

诊断检查

l IOP with tonometry

眼压计测量眼内压

l Visual acuity measurement and visual field perimetry

视敏度检查、视野检查

l Slit-lamp microscopy: in open-angle glaucoma, reveals a normal angle; in angle-closure glaucoma, reveals markedly narrow or flat anterior chamber angle, edematous cornea, and a fixed, moderately dilated pupil

裂隙灯镜检：开角青光眼显示为正常角；闭角青光眼显示为前房角的明显狭窄或扁平状、角膜水肿、瞳孔固定或中度散大

l Ophthalmoscopy (direct and indirect) for optic disc cupping

视神经乳头检眼镜检查

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治疗

If not recognized and treated, glaucoma may cause blindness that could have been prevented in most patients. The primary focus of therapy is to keep the IOP low enough to prevent the patient from developing optic nerve damage. Specific therapies vary with the type of glaucoma.

多数青光眼病人是可以治疗的，　但是，如果没有及时识别和治疗，青光眼也可以致盲。治疗的基本点是使眼内压保持较低水平，防止视神经损坏。根据青光眼类型可以采取不同的具体疗法。

l In open-angle (chronic) glaucoma, initial pharmacologic management can include β-adrenergic receptor blocking agents, adrenergic agents, cholinergic agents (miotics), and carbonic anhydrase inhibitors.

治疗开角（慢性)青光眼的初始药物包括β－肾上腺素能受体阻断剂、肾上腺素能药、胆碱能药（缩瞳药)和碳酸酐酶抑制剂。

l Surgical management may include argon laser trabeculoplasty, trabeculectomy, cyclocryotherapy, and Molteno implant.

外科手术包括氩激光小梁成形术、小梁切除术、睫状体冷冻疗法、Molteno植入法。

l Acute angle-closure glaucoma is an ocular emergency that requires immediate management, including topical cholinergic and hyperosmotic agents with laser peripheral iridotomy or surgery iridectomy.

急性闭角青光眼属于眼科急诊，需要立即进行治疗，包括胆碱能和局部用药，配合激光周边虹膜切开术或手术虹膜切除术。

l Secondary glaucoma is managed by treating the underlying problem and using antiglaucoma drugs.

继发性青光眼可以通过治疗潜在疾病及用抗青光眼药物进行治疗。

Nursing Management

护理

Nursing management needs to focus on the chronicity of the disease and preventing visual impairment.

护理重点是疾病的长期性和防止视力受损。

Goals

目标

l The patient with glaucoma will have no progression of visual impairment, understand the disease process and therapeutic rationale, comply with all aspects of therapy (including medication administration and follow-up care), and have no postoperative complications.

青光眼病人视力损伤不再加剧，了解疾病过程和治疗原理，顺应治疗（包括给药和随访护理)，无术后并发症。

Nursing Diagnoses

护理诊断

Risk for noncompliance related to the inconvenience and side effects of glaucoma medications

有不顺应危险　与不便和青光眼药物副作用有关

Risk for injury related to visual acuity deficits

有受伤危险　与视敏度缺陷有关

Risk for self-care deficits related to visual acuity deficits

自我护理缺乏　与视敏度缺陷有关

Pain related to pathophysiologic process and surgical correction

疼痛　与病理生理过程和手术矫治有关

Nursing Interventions

护理措施

The patient with acute angle-closure glaucoma requires immediate medication to lower the IOP. This patient may also be uncomfortable, and nursing comfort interventions may include darkening the environment, applying cool compresses to the patient's forehead, and providing a quiet and private space.

急性闭角青光眼病人必须立即应用药物降低眼内压。病人也可能很不舒服，应对病人进行安慰，包括弄暗环境，前额冷敷，提供安静的私密空间。

l Most surgical procedures for glaucoma are done on an outpatient basis. The patient needs postoperative instructions and nursing comfort measures to relieve discomfort.

多数青光眼手术是在门诊进行的，病人需要有术后指导和进行护理安慰，减轻不适。

l The patient with glaucoma needs encouragement to follow therapy recommendations, including information about the disease processes, normal course of the condition, and treatment options, including the rationale underlying each option.

应鼓励青光眼病人遵守治疗建议，包括疾病过程信息，正常病程和治疗方案及其原理。

Patient Teaching

病人宣教

l It is important to educate the patient and family about the risk of glaucoma. In addition, stress the importance of early detection and treatment in preventing visual impairment.

对病人及其家属进行青光眼危险教育很重要，还要强调早期发现和治疗对防止视力受损的重要性。

l The patient should know that the incidence of glaucoma increases with age and that a comprehensive ophthalmic examination is invaluable in identifying persons with glaucoma or at risk for developing glaucoma.

病人应该知道青光眼发病率是随着年龄增长面而增加的，全面的眼科检查对发现青光眼病人或有青光眼危险的病人非常有价值。

l The patient with glaucoma needs information about prescribed antiglaucoma agents.

青光眼病人需要了解抗青光眼处方药相关信息。