Who you are :
You are an FY2 in the Emergency Department.Who the patient is:
Mrs Monica Thomas, aged 55 years old, went to the optometrist, who told her that the pressure inside her eye is raised.What you should do:
Talk to her and address her concerns.
Symptoms of Open angle glaucoma:
Picked up during a routine eye test, often before it causes any noticeable symptoms.
Patchy blind spots in your side (peripheral) and reduced vision.
No eye pain but if it turns into acute glaucoma, it may present as angle-closure glaucoma.
DD
D: Any fever or flu-like symptoms?
P: No.
D: Any nausea?
P: No
D: Did you vomit?
P: No.
D: Do you see any rings around lights?
P: No.
D: Have you noticed any redness in your eyes?
P: No.
D: Any burning sensation, any gritty sensation, or any sticky discharge? (Conjunctivitis)
P: No.
D: Any joint pain? Wee problem? (Reiter’s)
P: No.
P2+ MAFTOSA
D: Have you had a similar kind of problem in the past?
P: No.
D: Have you been diagnosed with any medical condition in the past?
P: Yes. I have depression.
D: Since when?
P: 6 months
D: How is it managed?
P: I am taking Amitriptyline.
D: Are you taking the medication regularly?
P: Yes.
D: Any other medical condition such as IBD, AS or RA?
P: No.
D: Are you taking any other medications including OTC or supplements?
P: No.
D: Any allergies from any food or medications?
P: No.
D: Any previous hospital stays or surgeries?
P: No.
D: Has anyone in your family been diagnosed with any medical condition?
P: No.
DESA:
D: What you do for a living?
P: Office work.
EXAMINATION:
If it’s OK with you I would like to take your vitals and examine your eye.
YOU MAY BE HANDED A PICTURE OF THE PATIENT’S EYES: RED EYE AND DILATED PUPIL.
MANAGEMENT:
EXPLAIN DIAGNOSIS:
Based on what you have told me and from my assessment, I suspect you have open angle glaucoma. It’s a condition in which the pressure in your eye is higher than normal causing some damage in the peripheral part of the back of your eye. This part of the eye is called the retina and it is responsible for your vision. That is why you’re struggling to see at the peripheries of your visual field.
Senior.
Refer to a specialist eye doctor (ophthalmologist) for further tests.
(Routine referral)
Investigations:
- Gonioscopy is an examination to look at the front part your eye, this is where the fluid should drain out of your eye to determine whether this area (the “angle”) is open or closed (blocked), which can affect how fluid drains out of your eye.
- Visual field test: checks for missing areas of vision.
- Optic nerve assessment: The optic nerve, which connects your eye to your brain, can become damaged in glaucoma, so an assessment may be carried out to see if it’s healthy.
NB: For the test, eyedrops will be used to enlarge your pupils. The eyedrops used to widen your pupils could temporarily affect your ability to drive, so you’ll need to make arrangements for getting home after your appointment.
Symptomatic:
- Treatment can’t reverse any loss of vision that has already occurred, but it can help stop your vision getting any worse.
- Eye drops:
- The main treatment. they work by reducing the pressure in your eyes.
- They’re normally used between 1 and 4 times a day. It’s important to use them as directed, even if you haven’t noticed any problems with your vision. Your sight is at risk if you don’t stick to the recommended treatment.
- You may need to try several types before you find the one that works best for you. Sometimes you may need to use more than one type at a time.
- Eye drops can cause unpleasant side effects, such as eye irritation.
- Laser treatment or surgery may be offered if drops don’t help.
Safety-netting:
- You will need advice from your eye specialist and DVLA regarding driving.
- If you experience any pain or redness in your eye, please come to the hospital immediately. Acute angle closure glaucoma.
- You’ll also be advised to attend regular follow-up appointments to monitor your eyes and check that treatment is working. It’s important not to miss any of these appointments.
ACUTE ANGEL CLOSURE GLAUCOMA:
- SEVERE PAIN (SOCRATES) HEADACHE AND VISION PROBLEMS (ODIPARA)
- MEDICATIONS (AMYTRIPTALINE)
- URGENT REFERRAL
- SPECIALIST-MEDS - SURGERY
- DRIVING
OPEN ANGLE GLAUCOMA:
- PAINLESS VISION PROBLEMS
- EXCLUDE RED FLAGS DDX AND MEDICAL CONDITIONS (DM)
- ROUTINE REFERRAL – SPECIALIST- MEDS
- DRIVING AND AACG