3 Glaucoma Nursing Care Plans


Glaucoma or Increased intraocular pressure (IOP) is the result of inadequate drainage of aqueous humor from the anterior chamber of the eye. It is a condition that causes damage to your eye’s optic nerve and gets worse over time. The increased pressure causes atrophy of the optic nerve and, if untreated, blindness. Glaucoma tends to be inherited and may not show up until later in life.

There are two primary categories of glaucoma: (1) open-angle and (2) closed-angle (or narrow angle). Chronic open-angle glaucoma is the most common type, accounting for 90% of all glaucoma cases. It develops slowly, may be associated with diabetes and myopia, and may develop in both eyes simultaneously. Chronic glaucoma has no early warning signs, and the loss of peripheral vision occurs so gradually that substantial optic nerve damage can occur before glaucoma is detected.

Narrow-angle, or angle-closure, glaucoma is the less common form and may be associated with eye trauma, various inflammatory processes, and pupillary dilation after the instillation of mydriatic drops. Acute angle-closure glaucoma is manifested by sudden excruciating pain in or around the eye, blurred vision, and ocular redness. This condition constitutes a medical emergency because blindness may suddenly ensue.

Nursing Care Plans

Nursing care planning and management for patients with glaucoma include: preventing further visual deterioration, promote adaptation to changes in reduced visual acuity, prevent complications and injury.

Here are three (3) nursing care plans (NCP) and nursing diagnosis for glaucoma: 

  1. Disturbed Sensory Perception: Visual
  2. Anxiety
  3. Deficient Knowledge
  4. Other Possible Nursing Care Plans

Disturbed Visual Sensory Perception

Nursing Diagnosis

  • Disturbed Sensory Perception

May be related to

  • Altered sensory reception: altered status of sense organ

Possibly evidenced by

  • Progressive loss of visual field

Desired Outcomes

  • Client will participate in the therapeutic regimen.
  • Client will maintain the current visual field/acuity without further loss.
Nursing InterventionsRationale
Determine type and degree of visual loss.Affects choice of interventions and patient’s future expectations.
Allow expression of feelings about loss and possibility of loss of vision.Although early intervention can prevent blindness, the patient faces the possibility or may have already experienced a partial or complete loss of vision. Although vision loss cannot be restored (even with treatment), a further loss can be prevented.
Implement measures to assist patient to manage visual limitations such as reducing clutter, arranging furniture out of travel path; turning head to view subjects; correcting for dim light and problems of night vision.Reduces safety hazards related to changes in visual fields or loss of vision and papillary accommodation to environmental light.
Demonstrate administration of eye drops (counting drops, adhering to the schedule, not missing doses).Controls IOP, preventing further loss of vision.
Assist with administration of medications as indicated:These direct-acting topical myotic drugs cause pupillary constriction, facilitating the outflow of aqueous humor and lowering IOP. Note: Ocusert is a disc (similar to a contact) that is placed in the lower eyelid, where it can remain for up to 1 wk before being replaced.
Stress the importance of meticulous compliance with prescribed drug therapy:To prevent an increase in IOP, resulting in disk changes and loss of vision.
  • Chronic, open-angle glaucoma Pilocarpine hydrochloride (Isopto Carpine, Ocusert [disc], Pilopine HS gel)
Beta-blockers decrease the formation of aqueous humor without changing pupil size, vision, or accommodation. Note: These drugs may be contraindicated or require close monitoring for systemic effects in the presence of bradycardia or asthma.
  • Timolol maleate (Timoptic), betaxolol (Betoptic), carteolol (Ocupress), metipranolol (OptiPranolol), levobunolol (Betagan)
Carbonic anhydrase inhibitors decrease the rate of production of aqueous humor. Note: Systemic adverse effects are common, including mood disturbances, GI upset, and fatigue.
  • Acetazolamide (Diamox), methazolamide (Neptazane), dorzolamide (Trusopt)
Contracts the sphincter muscles of the iris, deepens anterior chamber and dilates vessels of outflow tract during an acute attack or before surgery.
  • Narrow-angle (angle-closure) type Myotics (until the pupil is constricted); Carbonic anhydrase inhibitors like acetazolamide (Diamox); dichlorphenamide (Daranide); methazolamide (Neptazane);
Decreases secretion of aqueous humor and lowers IOP.
  • Sympathomimetics: dipivefrin (Propine), brimonidine (Alphagan), epinephrine (Epifrin), apraclonidine (Iopidine), latanoprost (Xalatan);
Adrenergic drops also decrease the formation of aqueous humor and may be beneficial when the patient is unresponsive to other medications. Although free of side effects such as miosis, blurred vision, and night blindness, they have the potential for additive adverse cardiovascular effects in combination with other cardiovascular agents. Note: Light-colored eyes are more responsive to these drugs than dark-colored eyes, necessitating added considerations when determining appropriate dosage.
Provide sedation, analgesics as necessary.Acute glaucoma attack is associated with sudden pain, which can precipitate anxiety and agitation, further elevating IOP. Medical management may require 4–6 hr before IOP decreases and pain subsides.
Prepare for surgical intervention as indicated:

  • Laser therapy such as argon laser trabeculoplasty (ALT), trabeculectomy or trephination
Filtering operations (laser surgery) are highly successful procedures for reducing IOP by creating an opening between the anterior chamber and the subjunctival spaces so that aqueous humor can bypass the trabecular mesh block. Note: Apraclonidine (Lopidine) eye drops may be used in conjunction with laser therapy to lessen or prevent postprocedure elevations of IOP.
  • Iridectomy
Surgical removal of a portion of the iris facilitates drainage of aqueous humor through a newly created opening in the iris connecting to normal outflow channels. Note: Bilateral iridectomy is performed because glaucoma usually develops in the other eye.
Postoperative care after peripheral iridectomy includes cycloplegic eye drops.To relax the ciliary muscle and to decrease inflammation, thus preventing adhesions. Cycloplegics must be used only in the affected eye. the use of these drops in the normal eye may precipitate an attack of acute angle-closure glaucoma in this eye, threatening the patient’s residual vision.
  • Malento valve implant
Separates ciliary body from the sclera to facilitate outflow of aqueous humor.
  • Cyclocryotherapy
Used in intractable glaucoma.
  • Diathermy or cryosurgery
If other treatments fail, destruction of the ciliary body reduces the formation of aqueous humor
Experimental ocular implant device corrects and prevents scarring over or closure of drainage sac created by trabeculectomy.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

Other ophthalmic nursing care plans:


Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
  • Hello, just wanted to alert you that the description for meds are switched up. Timolol is beta blocker (not carbonic anhydrase inhibitor) pilocarpic is cholinergic which contracts the iris (not beta blocker) and acetazolamide is carbonic anhydrase inhibitor. There must have been a mix up when creating the table. My prof shared this with the class and I was like wait a min but she didnt believe me because nursing profs act like they know everything and are infallible and students are never right. This type of toxic culture that exists in nursing education can really be discouraging. One day I will be the nursing prof who is different and treats everyone with empathy, compassion, and respect.

    • I completely understand. I am in the final months of nursing school. It’s not that easy to just switch instructors. I wish it was. Anyway thank you for wanting to be that better person/Instructor. I have the same plan.

    • Thank you for sharing BeAnon, I feel you in so many levels. The good thing is that not every professor is/has been like that, but there are a few that are. I’m happy to hear you want make it to a Nurse educator and be a better professor, that those who just “know it all”. Good luck in your nursing journey.

  • Sir, not all professors act alike. As with ethnic groups, generalizations about anyone are very damaging and borne of ignorance.
    If you have a professor who “acts like they know everything,” I suggest you find a new professor. Even those of us with doctoral degrees continue to learn every day. That’s why the NLN espouses the Spirit of Inquiry.

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