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Diseases » Glaucoma » Treatments

Treatments for Glaucoma



Contents

Treatments for Glaucoma

The list of treatments mentioned in various sources for Glaucoma includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

  • Eye drops - to reduce pressure
    • Betoptic
    • Pilocarpine
    • Timoptic
    • Iopidine
    • Alphagan
    • Propine
    • Trusopt
    • Xalatan
  • Medications
  • Laser eye surgery - - improve the drainage tissue in the eye so more fluid flows out more easily, reducing pressure
  • Laser trabeculoplasty - a form of laser eye surgery
  • Conventional eye surgery - non-laser surgery
  • Trabulectomy
  • Emergency hospitalization - for the less common type: closed-angle glaucoma or acute glaucoma; this type is a medical emergency.
  • Topical administration of calcium channel blocking agents
  • Argon laser trabeculoplasty (ALT)
  • Selective laser trabeculoplasty (SLT)
  • Trabeculectomy
  • Trabeculoplasty
  • Treat the underlying cause
  • Beta -adrenergic antagonists
  • Parasympthomimetics
  • Alpha- adrenergic agonists
  • Carbonic anhydrase inhibitors
  • Prostaglandin analogs
  • Laser iridectomy
  • Filtering surgery
  • Drugs to lower intraocular pressure Prostaglandin analogues
  • Topical beta adrenergic receptor antagonists
  • Sympathomimetics
  • Miotic agents
  • Physostigmine
  • Canaloplasty
  • Nd:YAG laser peripheral iridotomy
  • Glaucoma drainage implants

Glaucoma: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Glaucoma may include:

Hidden causes of Glaucoma may be incorrectly diagnosed:

Glaucoma: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Glaucoma:

Curable Types of Glaucoma

Possibly curable types of Glaucoma may include:

Glaucoma: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Glaucoma:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Glaucoma include:

  • Acetazolamide
  • Acetazolam
  • Diamox
  • Diamox Sequels
  • Diamox Sustained Release
  • Epifrin
  • E-Pilo Preparations
  • Epinal Ophthalmic
  • EpiPen
  • Epitrate
  • Marcaine
  • Medihaler-Epi Preparations
  • Micronephrine
  • Norocaine
  • Octocaine
  • P1E1
  • P2E2
  • P3E1
  • P4E1
  • P6E1
  • Latanoprost
  • Xalatan
  • Pilocarpine
  • Adsorbocarpine
  • Akarpine
  • Almocarpine
  • I-Pilopine
  • Isopto Carpine
  • Minims
  • Miocarpine
  • Ocusert Pilo-20
  • Ocusert Pilo 40
  • PE Preparations
  • Pilagan
  • Pilocar
  • Pilopine HS
  • Piloptic-1
  • Piloptic-2
  • Pilosyst 20/40
  • Salagen
  • Spersacarpine
  • Timolol
  • Apo-Timolol
  • Apo-Timop
  • Betimol
  • Blocadren
  • Cosopt
  • Dom-Timolol
  • Novo-Timolol
  • Timolide
  • Timoptic
  • Timoptic Ouches
  • Timoptic-XE
  • Travoprost
  • Travatan
  • Carbachol
  • Isopto Carbachol
  • Miostat
  • Carbastat
  • Dorzolamide and Timolol
  • Apraclonidine - mainly used for severe glaucoma
  • Iodipine - mainly used for severe glaucoma
  • Dipoquin
  • Dipivefrine Hydrochloride
  • Propine

Latest treatments for Glaucoma:

The following are some of the latest treatments for Glaucoma:

Hospital statistics for Glaucoma:

These medical statistics relate to hospitals, hospitalization and Glaucoma:

  • 0.11% (13,486) of hospital episodes were for glaucoma in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 99% of hospital consultations for glaucoma required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 46% of hospital episodes for glaucoma were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 54% of hospital episodes for glaucoma were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 16% of hospital admissions for glaucoma required emergency hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • more hospital information...»

Hospitals & Medical Clinics: Glaucoma

Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Glaucoma:

Hospital & Clinic quality ratings » »

Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Glaucoma, on hospital and medical facility performance and surgical care quality:

Medical news summaries about treatments for Glaucoma:

The following medical news items are relevant to treatment of Glaucoma:

Discussion of treatments for Glaucoma:

Keep your eyes healthy: NIDDK (Excerpt)

Without treatment, you can go blind. Treating glaucoma is usually simple. Your eye doctor will give you special drops to use every day to lower the pressure in your eye. Or your eye doctor may want you to have laser surgery. (Source: excerpt from Keep your eyes healthy: NIDDK)

Are You at Risk for Glaucoma: NEI (Excerpt)

Although open-angle glaucoma cannot be cured, it can usually be controlled. The most common treatments are:

Medications: These may be either in the form of eye drops or pills. Some drugs are designed to reduce pressure by slowing the flow of fluid into the eye. Others help to improve fluid drainage.

For most people with glaucoma, regular use of medications will control the increased fluid pressure. But, these drugs may stop working over time. Or, they may cause side effects. If a problem occurs, the eye care professional may select other drugs, change the dose, or suggest other ways to deal with the problem.

Laser surgery: During laser surgery, a strong beam of light is focused on the part of the anterior chamber where the fluid leaves the eye. This results in a series of small changes, which makes it easier for fluid to exit the eye. Over time, the effect of laser surgery may wear off. Patients who have this form of surgery may need to keep taking glaucoma drugs.

Surgery: Surgery can also help fluid escape from the eye and thereby reduce the pressure. However, surgery is usually reserved for patients whose pressure cannot be controlled with eye drops, pills, or laser surgery. (Source: excerpt from Are You at Risk for Glaucoma: NEI)

Facts About Glaucoma: NEI (Excerpt)

Although you will never be cured of glaucoma, treatment often can control it. This makes early diagnosis and treatment important to protect your sight. Most doctors use medications for newly diagnosed glaucoma; however, new research findings show that laser surgery is a safe and effective alternative.

Glaucoma treatments include:

Medicine: Medicines are the most common early treatment for glaucoma. They come in the form of eyedrops and pills. Some cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.

Glaucoma drugs may be taken several times a day. Most people have no problems. However, some medicines can cause headaches or have side effects which affect other parts of the body. Drops may cause stinging, burning, and redness in the eye. Ask your eye care professional to show you how to put the drops into your eye. In addition, tell your eye care professional about other medications you may be taking before you begin glaucoma treatment.

Many drugs are available to treat glaucoma. If you have problems with one medication, tell your eye care professional. Treatment using a different dosage or a new drug may be possible.

You will need to use the drops and/or pills as long as they help to control your eye pressure. This is very important. Because glaucoma often has no symptoms, people may be tempted to stop or may forget to take their medicine.

Laser surgery (also called laser trabeculoplasty):Laser surgery helps fluid drain out of the eye. Although your eye care professional may suggest laser surgery at any time, it is often done after trying treatment with medicines. In many cases, you will need to keep taking glaucoma drugs even after laser surgery.

Laser surgery is performed in an eye care professional's office or eye clinic. Before the surgery, your eye care professional will apply drops to numb the eye.

As you sit facing the laser machine, your eye care professional will hold a special lens to your eye. A high-energy beam of light is aimed at the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes 50-100 evenly spaced burns. These burns stretch the drainage holes in the meshwork. This helps to open the holes and lets fluid drain better through them.

Your eye care professional will check your eye pressure shortly afterward. He or she may also give you some drops to take home for any soreness or swelling inside the eye. You will need to make several followup visits to have your pressure monitored.

Once you have had laser surgery over the entire meshwork, further laser treatment may not help. Studies show that laser surgery is very good at getting the pressure down. But its effects sometimes wear off over time. Two years after laser surgery, the pressure increases again in more than half of all patients.

Conventional surgery: The purpose of surgery is to make a new opening for the fluid to leave the eye. Although your eye care professional may suggest it at any time, this surgery is often done after medicine and laser surgery have failed to control your pressure.

Surgery is performed in a clinic or hospital. Before the surgery, your eye care professional gives you medicine to help you relax and then small injections around the eye to make it numb.

The eye care professional removes a small piece of tissue from the white (sclera) of the eye. This creates a new channel for fluid to drain from the eye. But surgery does not leave an open hole in the eye. The white of the eye is covered by a thin, clear tissue called the conjunctiva. The fluid flows through the new opening, under the conjunctiva, and drains from the eye.

You must put drops in the eye for several weeks after the operation to fight infection and swelling. (The drops will be different than the eyedrops you were using before surgery.) You will also need to make frequent visits to your eye care professional. This is very important, especially in the first few weeks after surgery.

In some patients, surgery is about 80 to 90 percent effective at lowering pressure. However, if the new drainage opening closes, a second operation may be needed. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation.

Keep in mind that while glaucoma surgery may save remaining vision, it does not improve sight. In fact, your vision may not be as good as it was before surgery.

Like any operation, glaucoma surgery can cause side effects. These include cataract, problems with the cornea, inflammation or infection inside the eye, and swelling of blood vessels behind the eye. However, if you do have any of these problems, effective treatments are available. (Source: excerpt from Facts About Glaucoma: NEI)

Book Excerpts: Treatment of Glaucoma

Treatments of Glaucoma: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Glaucoma.

Hypertension: Treatment
(In a Page: Signs and Symptoms)

  • Essential hypertension: Lifestyle changes are the initial interventions unless significant hypertension, end-organ damage, or diabetes is present (smoking cessation; dietary changes, e.g., DASH diet =low in sodium, rich in potassium and calcium; increased exercise)
  • Pharmacologic therapy usually begins with a diuretic or β-blocker (ACE inhibitor in diabetics)
    –Diuretics are usually first-line agents, especially in CHF, diabetes, and risk of coronary artery disease
    –Use ACE inhibitors in patients with CHF, MI, renal disease, and diabetes
    –Use β-blockers in CAD, recent MI, angina, CHF, atrial fibrillation, migraines, hyperthyroidism
    –Additional drugs may include angiotensin receptor blockers (especially in patients with cough when using ACE inhibitors), calcium channel blockers, and β-blockers
    –Preferred drugs in pregnancy include methyldopa, β-blockers, and vasodilators (do not use ACE/ARBs)
'>

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Hypertension: Treatment
(In A Page: Pediatric Signs and Symptoms)

  • Treat the underlying disease when possible
  • Stop smoking and illicit drug use
  • Avoid the offending drug when possible
  • Limit competitive sports and highly static exercises in patients with severe hypertension only until their BP is controlled and there is no evidence of end organ damage
  • Salt restriction (4–5 g/day), weight loss, and exercise are part of most regimens
  • Essential hypertension can usually be resolved with weight loss, moderate exercise, and dietary modifications
  • For other etiologies, many medications are used to control blood pressure
    –IV: Nicardipine, sodium nitroprusside, labetalol
    –Oral: Captopril, enalapril, lisinopril, amlodipine, nifedipine extended release, propranolol, clonidine, hydralazine

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

The National Institutes of Health recommend the following approach for treating primary hypertension:

❑ First, help the patient initiate necessary lifestyle modifications, including weight reduction, moderation of alcohol intake, regular physical exercise, reduction of sodium intake, and smoking cessation.

❑ If the patient fails to achieve the desired blood pressure or make significant progress, continue lifestyle modifications and begin drug therapy.

❑ For stage 1 hypertension (systolic [SBP] blood pressure 140 to 159 mm Hg, or diastolic blood pressure [DBP] 90 to 99 mm Hg) in the absence of compelling indications (heart failure, postmyocardial infarction, high coronary disease risk, diabetes, chronic kidney disease, or recurrent stroke prevention), give most patients thiazide-type diuretics. Consider using an angiotensin-converting enzyme (ACE) inhibitor, beta-adrenergic blocker, calcium channel blocker (CCB), angiotensin-receptor blocker (ARB), or a combination.

❑ For stage 2 hypertension (SBP ≥ 160 mm Hg, or DBP ≥ 100 mm Hg) in the absence of compelling indications, give most patients a two-drug combination (usually a thiazide-type diuretic and an ACE inhibitor, ARB, CCB, or beta-adrenergic blocker).

❑ If the patient has one or more compelling indications, base drug treatment on benefits from outcome studies or existing clinical guidelines. Treatment may include the following, depending on indication:

–  Heart failure — diuretic, beta-adrenergic blocker, ACE inhibitor, ARB, or aldosterone antagonist

–  High coronary disease risk — diuretic, beta-adrenergic blocker, ACE inhibitor, or CCB

–  Diabetes — diuretic, beta-adrenergic blocker, ACE inhibitor, or CCB

–  Chronic kidney disease — ACE inhibitor or ARB

–  Postmyocardial failure — ACE inhibitor, beta-adrenergic blocker, or aldosterone antagonist

–  Recurrent stroke prevention — diuretic or ACE inhibitor.

Give other antihypertensive drugs as needed.

❑ If the patient fails to achieve the desired blood pressure, continue lifestyle modifications and optimize drug dosages or add additional drugs until the goal blood pressure is achieved. Also, consider consultation with a hypertension specialist.

Treatment of secondary hypertension focuses on correcting the underlying cause and controlling hypertensive effects.

Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidine, or labetalol, to rapidly reduce blood pressure. The initial goal is to reduce mean arterial blood pressure by no more than 25% (within minutes to hours) then to 160/110 within 2 hours while avoiding excessive falls in blood pressure that can precipitate renal, cerebral, or myocardial ischemia.

Examples of hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage, acute left-sided heart failure with pulmonary edema, and dissecting aortic aneurysm. Hypertensive emergencies are also associated with eclampsia or severe gestational hypertension, unstable angina, and acute myocardial infarction.

Hypertension without accompanying symptoms or target-organ disease seldom requires emergency drug therapy.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Glaucoma: Treatment
(Professional Guide to Diseases (Eighth Edition))

For chronic open-angle glaucoma, treatment initially decreases IOP through the use of an alpha antagonist, brimonidine tartrate (Alphagan), and then beta blockers, such as timolol (contraindicated for asthmatics or patients with bradycardia) or betaxolol (Betoptic) to reduce aqueous humor production. A topical anhydrase inhibitor is used in preference to a systemic anhydrase inhibitor such as acetazolamide. A tubo-plast or tube shunt or valve may also be used. Miotic eyedrops such as pilocarpine facilitate the outflow of aqueous humor.

Patients who are unresponsive to drug therapy may be candidates for argon laser trabeculoplasty (ALT) or a surgical filtering procedure called trabeculectomy, which creates an opening for aqueous outflow. In ALT, an argon laser beam is focused on the trabecular meshwork of an open angle. This produces a thermal burn that changes the surface of the meshwork and increases the outflow of aqueous humor. In trabeculectomy, a flap of sclera is dissected free to expose the trabecular meshwork. Then this discrete tissue block is removed and a peripheral iridectomy is performed. This produces an opening for aqueous outflow under the conjunctiva, creating a filtering bleb. In chronic refractory glaucoma, a tubo-plast or tube shunt or valve is used to keep IOP within normal limits.

Acute angle-closure glaucoma is an ocular emergency requiring immediate treatment to lower the high IOP. Preoperative drug therapy lowers IOP with I.V. acetazolamide, pilocarpine (constricts the pupil, forcing the iris away from the trabeculae, allowing fluid to escape), timolol, and a topical steroid to quiet the inflammatory response, along with I.V. mannitol (20%) or oral glycerin (50%) to force fluid from the eye by making the blood hypertonic. Latanoprost is a topical medication that helps drain the aqueous outflow from the eye and lower the IOP. Oral medication or topical drops may be prescribed separately or in combination. Severe pain may necessitate administration of opioid analgesics. If pressure doesn’t decrease with drug therapy, laser iridotomy or surgical peripheral iridectomy must be performed promptly to save the patient’s vision. Iridectomy relieves pressure by excising part of the iris to reestablish aqueous humor outflow. A prophylactic iridectomy is performed a few days later on the other eye to prevent an acute episode of glaucoma in the normal eye.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Hypertensive crisis: Treatment (Tx)
(Professional Guide to Diseases (Eighth Edition))

Nitroprusside, nitroglycerin, diazoxide, hydralazine, methyldopa

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Renovascular hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

Surgery, the treatment of choice, is performed to restore adequate circulation and to control severe hypertension or severely impaired renal function by renal artery bypass, endarterectomy, arterioplasty or, as a last resort, nephrectomy. Balloon catheter renal artery dilation is used in selected cases to correct renal artery stenosis without the risks and morbidity of surgery. Symptomatic measures include antihypertensives, diuretics, and a sodium-restricted diet.

Medications that may be used in an attempt to control blood pressure include diuretics, beta-adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and alpha-adrenergic blockers. Diazoxide or nitroprusside may be given in the hospital if symptoms are acute. Response to medications is highly individual and the dosage or specific drug used may need frequent adjustment.

Lifestyle changes may be recommended, including weight, exercise, dietary adjustments, smoking cessation, and avoidance of alcohol. These habits add to the effects of hypertension in causing complications.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Pregnancy-induced hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

Therapy for preeclampsia is designed to halt the disorder’s progress — specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown — and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include complete bed rest to increase placental perfusion, reduce hypertension, and evaluate response to therapy. Antihypertensive therapy doesn’t alter the potential for developing eclampsia. Diuretics aren’t appropriate during pregnancy.

If the patient’s blood pressure fails to respond to bed rest and sedation and persistently rises above 160/100 mm Hg, or if central nervous system irritability increases, magnesium sulfate may produce general sedation, promote diuresis, and prevent seizures. Cesarean birth or oxytocin induction may be required to terminate the pregnancy.

Emergency treatment of eclamptic seizures consists of immediate administration of magnesium sulfate (I.V. drip), oxygen administration, and electronic fetal monitoring. After the seizures subside and the patient’s condition stabilizes, delivery should proceed with induction of labor or cesarean birth, depending upon the circumstances.

Adequate nutrition, good prenatal care, and control of pre-existing hypertension during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Pulmonary hypertension: Treatment
(Professional Guide to Diseases (Eighth Edition))

Treatment usually includes oxygen therapy to decrease hypoxemia and resulting pulmonary vascular resistance. It may also include vasodilator therapy (nifedipine, diltiazem, or prostaglandin E). For patients with right-sided heart failure, treatment also includes fluid restriction, cardiac glycosides to increase cardiac output, and diuretics to decrease intravascular volume and extravascular fluid accumulation. Treatment also aims to correct the underlying cause.

Some patients with pulmonary hypertension may be candidates for heart-lung transplantation to improve their chances of survival.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Blood pressure increase [Hypertension]: Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))

Encourage the patient to lose weight, if necessary, and to restrict sodium intake. Suggest that he participate in an exercise or stress management program as well. Then teach the patient how to monitor his blood pressure so that he can evaluate the effectiveness of drug therapy and lifestyle changes. Have him record blood pressure readings and symptoms, and ask him to share this information on his return visits.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Hypertension: Treatment
(Handbook of Diseases)

Secondary hypertension treatment focuses on correcting the underlying cause and controlling hypertensive effects.

The National Institutes of Health recommend the following approach for treating primary hypertension:

❑ First, help the patient initiate necessary lifestyle modifications, including weight reduction, moderation of alcohol intake, regular physical exercise, reduction of sodium intake, and smoking cessation.

❑ If the patient fails to achieve the desired blood pressure or make significant progress, continue lifestyle modifications and begin drug therapy.

❑ For stage 1 hypertension (systolic [SBP] blood pressure 140 to 159 mm Hg, or diastolic blood pressure [DBP] 90 to 99 mm Hg) in the absence of compelling indications (heart failure, postmyocardial infarction, high coronary disease risk, diabetes, chronic kidney disease, or recurrent stroke prevention), give most patients thiazide-type diuretics. Consider using an angioten-sin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-adrenergic blocker (BB), calcium channel blocker (CCB), or a combination.

❑ For stage 2 hypertension (SBP ≥ 60 mm Hg, or DBP ≥ 100 mm Hg) in the absence of compelling indications, give most patients a two-drug combination (usually a thiazide-type diuretic and an ACEI, ARB, BB, or CCB).

❑ If the patient has one or more compelling indications, base drug treatment on benefits from outcome studies or existing clinical guidelines. Treatment may include the following, depending on indication:

❑ Heart failure — diuretic, BB, ACEI, ARB, or aldosterone antagonist

❑ Post myocardial infarction — BB, ACEI, or aldosterone antagonist

❑ High coronary disease risk — diuretic, BB, ACEI, or CCB

❑ Diabetes — diuretic, BB, ACEI, ARB, or CCB

❑ Chronic kidney disease — ACEI or ARB

❑ Recurrent stroke prevention — diuretic or ACEI.

Give other antihypertensive drugs as needed.

❑ If the patient fails to achieve the desired blood pressure, continue lifestyle modifications and optimize drug dosages or add additional drugs until the goal blood pressure is achieved. Also, consider consultation with a hypertension specialist.

UNDER STUDY: Studies have shown that omega-3 fatty acids used in the treatment of hypertension significantly reduce total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels and lower systolic and diastolic blood pressure.

Clinical tip  The treatment for renal artery stenosis includes the use of ACE inhibitors and renal artery stents.

Hypertensive emergencies

Examples of hypertensive emergencies include hypertensive encephalopathy, intracranial hemorrhage, acute left-sided heart failure with pulmonary edema, and dissecting aortic aneurysm. Hypertensive emergencies are also associated with eclampsia and severe pregnancy-induced hypertension, unstable angina, and acute MI.

Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidine, or labetalol, to rapidly reduce blood pressure.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Glaucoma: Treatment
(Handbook of Diseases)

Drug therapy is the treatment of choice for chronic open-angle glaucoma. If this fails, argon laser trabeculoplasty or trabeculectomy is performed. Acute angle-closure glaucoma is treated with drugs, laser iridotomy, or surgical peripheral iridectomy.

Drug therapy for chronic open-angle glaucoma

For chronic open-angle glaucoma, treatment initially decreases aqueous humor production through beta-adrenergic blockers, such as timolol (contraindicated for patients with asthma or those with bradycardia) and betaxolol (a beta1-receptor antagonist); alpha agonists, such as brimonidine, to lower IOP; and topical carbonic anhydrase inhibitors such as dorzolamide.

Drug treatment also includes miotic eyedrops, such as pilocarpine, to facilitate the outflow of aqueous humor. Patients who are unresponsive to drug therapy may be candidates for iridectomy, a surgical filtering procedure that creates an opening for aqueous outflow.

Clinical tip  The end stage of glaucoma may require a tube shunt or valve to keep IOP down.

Argon laser trabeculoplasty

In argon laser trabeculoplasty, an argon laser beam is focused on the trabecular meshwork of an open angle. This produces a thermal burn that changes the surface of the meshwork and increases the outflow of aqueous humor.

Trabeculectomy

In trabeculectomy, a flap of sclera is dissected free to expose the trabecular meshwork. This discrete tissue block is then removed, and a peripheral iridectomy is performed. This procedure produces an opening for aqueous outflow under the conjunctiva, creating a filtering bleb.

Treatment for ACUTE angle-closure glaucoma

Acute angle-closure glaucoma is an ocular emergency that requires immediate treatment to lower the high IOP. If the pressure doesn’t decrease with drug therapy, laser iridotomy or surgical peripheral iridectomy must be performed promptly to save the patient’s vision.

Iridectomy relieves pressure by excising part of the iris to reestablish aqueous humor outflow. A prophylactic iridectomy is performed a few days later on the patient’s other eye to prevent an acute episode of glaucoma in that eye.

Preoperative drug therapy lowers IOP with I.V. mannitol and steroid drops to quell the inflammation. Acetazolamide is used as well as pilocarpine (which constricts the pupil, forcing the iris away from the trabeculae and allowing fluid to escape) and I.V. mannitol (20%) or oral glycerin (50%) to force fluid from the eye by making the blood hypertonic. Timolol is used to decrease IOP. Severe pain may necessitate narcotic analgesics.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Hypertension, pregnancy-induced: Treatment
(Handbook of Diseases)

Adequate nutrition, good prenatal care, and control of preexisting hypertension with hydralazine during pregnancy decrease the incidence and severity of preeclampsia. Early recognition and prompt treatment of preeclampsia can prevent progression to eclampsia.

Therapy for preeclampsia is designed to halt the disorder’s progress — specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown — and to ensure fetal survival. Some physicians advocate the prompt induction of labor, especially if the patient is near term; others follow a more conservative approach.

Conservative measures

Therapy may include sedatives, such as phenobarbital, along with complete bed rest to relieve anxiety, reduce hypertension, and evaluate response to therapy. If renal function remains adequate, a high-protein, low-sodium, low-carbohydrate diet with increased fluid intake is recommended.

If blood pressure fails to respond to bed rest and sedation and persistently rises above 160/100 mm Hg or if CNS irritability increases, magnesium sulfate may produce general sedation, promote diuresis, reduce blood pressure, and prevent seizures.

Cesarean delivery

If these measures fail to improve the patient’s condition or if fetal life is endangered (as determined by stress or nonstress tests), cesarean delivery or oxytocin induction may be required to terminate the pregnancy.

Treatment for seizures

Emergency treatment of eclamptic seizures consists of immediate administration of I.V. diazepam, followed by magnesium sulfate (I.V. drip), oxygen administration, and electronic fetal monitoring. After the patient’s condition stabilizes, a cesarean delivery may be performed.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Pulmonary hypertension: Treatment
(Handbook of Diseases)

Appropriate treatment usually includes oxygen therapy to decrease hypoxemia and resulting pulmonary vascular resistance. For patients with right-sided heart failure, treatment also includes fluid restriction, cardiac glycosides to increase cardiac output, and diuretics to decrease intravascular volume and extravascular fluid accumulation. An important goal of treatment is correction of the underlying cause.

CLINICAL TIP: Patients with primary pulmonary hypertension usually respond to epoprostenol (PGI2) as a continuous home infusion.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Halo vision: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Teach the patient how to properly instill eyedrops, if prescribed, and stress the importance of meticulous compliance. Tell him to report eye discharge, eye watering, blurred or cloudy vision, halos, floaters, flashes of light, or eye pain.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Halo vision: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ To help minimize halo vision, remind the patient not to look directly at bright lights.

Patient teaching

▪ Teach the patient how to instill eyedrops if prescribed.

▪ Discuss the importance of reporting eye discharge, eye watering, blurred or cloudy vision, halos, floaters, flashes of light, or eye pain.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Blood pressure, increased [Hypertension]: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ If routine screening detects elevated blood pressure, prepare the patient for routine blood tests, urinalysis, and depending on the suspected cause of the increased blood pressure, radiographic studies, especially of the kidneys.

▪ Administer antihypertensives, as ordered, and evaluate their effect.

Patient teaching

▪ Explain the importance of regular blood pressure monitoring and keeping follow-up appointments.

▪ Explain how to take prescribed antihypertensives correctly and adverse effects that should be reported.

▪ Instruct the patient not to discontinue medications without contacting the practitioner.

▪ Emphasize the importance of weight loss and regular exercise.

▪ Explain the need for sodium restriction.

▪ Discuss stress management.

▪ Discuss ways of reducing other risk factors for coronary artery disease, such as smoking cessation and lowering elevated cholesterol levels.

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Source: Nursing: Interpreting Signs and Symptoms, 2007


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