Full transcript
0:00hey everyone it's sarah with
0:01registerednessrn.com and in this video
0:03we're going to talk about glaucoma
0:05and as always whenever you get done
0:06watching this youtube lecture you can
0:08access the free quiz that will test you
0:10on this condition
0:12so let's get started glaucoma is a set
0:14of eye diseases that is caused by
0:16increased intraocular pressure and
0:19whenever this happens it results in
0:21optic nerve damage so what does our
0:24optic nerve do
0:25well this nerve helps transmit
0:27information that we see with our eyes
0:30to our brains so it plays a huge role in
0:32giving us our vision
0:34so if this nerve becomes damaged the
0:36person is going to have vision loss
0:38that can eventually lead to permanent
0:40blindness for instance if this patient
0:42had
0:43ankle glaucoma over time eventually they
0:46will notice that they're losing their
0:47peripheral vision which is going to give
0:49them like tunnel vision
0:50and if they don't get this treated where
0:52they're getting their interocular
0:54pressure
0:54lowered it can eventually lead to
0:56permanent blindness
0:58so in this lecture we're going to talk
0:59about two types of glaucoma
1:02the first type we're going to talk about
1:03is called open angle glaucoma
1:05and this type is the most common form of
1:08glaucoma
1:09now the thing you want to remember about
1:10this type is that its signs and symptoms
1:12are very subtle
1:14the patient's not going to really know
1:15that they have this type of glaucoma
1:17until the disease has really advanced
1:19so we refer to this type as the silent
1:22type
1:23the next type we're going to talk about
1:24is called angle closure glaucoma now you
1:27may also hear this referred to as
1:29narrow angle glaucoma or closed angle
1:32glaucoma
1:33all those terms refer to this type of
1:34glaucoma now this type of glaucoma is
1:37very
1:37rare and its signs and symptoms the
1:39patient is definitely going to notice
1:42them and whenever the patient has this
1:44type of glaucoma
1:45it requires immediate emergency
1:48treatment so as a nurse it's very
1:49essential that you know the differences
1:51between the signs and symptoms
1:53with open angle and ankle closure
1:55glaucoma
1:56now with all types of glaucoma you
1:58really want to stress to the patient
2:00that early detection
2:01is key because this disease can be
2:05detected on an eye exam
2:06that checks the intraocular pressure a
2:09little bit later we're going to talk
2:10about that specific exam
2:12so first let's talk about the
2:13pathophysiology of glaucoma
2:15and to help us truly understand this
2:18disease process
2:18we have to identify the key players that
2:21play a role in the pathophysiology
2:23so our key players are the intraocular
2:25pressure the iop
2:27and the aqueous humor so first let's
2:30talk about iop
2:31what is this well to help us understand
2:33that let's take that word apart
2:35intra means within and ocular means i so
2:38when we put that together
2:39we get the fluid pressure within the eye
2:42and the fluid that we're specifically
2:43talking about is the aqueous
2:45humor so intraocular pressure is
2:48calculated by the production rate and
2:51the drainage rate of this aqueous humor
2:54now aqueous humor is produced in the eye
2:56specifically by the ciliary
2:58body and it drains out through the eye
3:00and it's going to go through the
3:01trabecular
3:02meshwork into like the drainage canals
3:04so if your production rate and your
3:06drainage rate are not equal
3:08you're going to get increased
3:09interocular pressure but how in the
3:11world do we know a patient's iop
3:13well it can be detected through an eye
3:15exam and they can use a device called a
3:17tonometer
3:18and this device will tell us what the
3:20patient's iop is
3:22now generally a normal iop in most
3:25people is about 10
3:29to 21 millimeters of
3:32mercury so now let's talk about aqueous
3:35humor
3:35so we have established that this fluid
3:37helps maintain our iop
3:39but let's talk about how it really flows
3:42through this
3:43eye and really compare that to open and
3:46angle closure
3:47glaucoma so here we have our eye and the
3:50view of this eye is if you were looking
3:52over someone and you took their eyeball
3:54and you just cut it in half
3:56and you were just looking at it so this
3:57is the view of the eye that we're
3:58looking at
3:59and here in the drawing we have in red
4:01this is the
4:02ciliary body and that produces again the
4:04aqueous humor
4:06we have the lens we have in purple this
4:09represents the
4:10flow path of the aqueous humor and then
4:13here in black
4:14we have the pupil opening and then the
4:17colored area in green
4:19is the iris which is the color part of
4:20the eye so our person has green eyes
4:24and then we have the cornea which is
4:26this area here in black
4:28and then we have the trabecular meshwork
4:31and schlemm's canal and that's how the
4:33aqueous humor is going to
4:34leave this part of the eye so let's talk
4:36about how it flows
4:38normally so the ciliary body produces
4:41the aqueous
4:42humor and it's going to go through the
4:45posterior chamber of the eye
4:47and this is found between the iris and
4:50the lens
4:51then this aqueous humor is going to go
4:53through the pupil opening
4:55and it's going to enter into the
4:56anterior chamber of the eye
4:59which is found with the cornea and
5:02the iris then the aqueous humerus should
5:05normally go down
5:06and we're hitting the drainage angles of
5:08the eye and i want you to remember
5:09drainage angle because that is really
5:11the key concept
5:12in understanding closed angle or angle
5:14closure glaucoma
5:16versus open angle glaucoma so it's going
5:18to go down through these
5:19drainage angles and it's going to hit
5:21the trabecular
5:22meshwork okay it's mesh work so this
5:26trabecular mesh work is like a strainer
5:28area
5:28so the fluid is going to go down through
5:30there and then it's going to go into
5:32schwim's canal
5:33and then it's going to hit the
5:34episcleral veins and that's how it
5:36normally
5:37should drain out of the eye but to help
5:39give you a better
5:40illustration let's look at this
5:42animation so here is a
5:44side view of the eye if you took it and
5:46you cut it in half
5:48encircled in red is the ciliary body
5:50which produces that aqueous humor it's
5:52going to flow out through that posterior
5:54chamber
5:54through the pupillary open through the
5:57anterior
5:58chamber and then it's going to go down
6:00into the trabecular meshwork into the
6:02schlemm's canal in the episclerial veins
6:04so as you can see this aqueous humor is
6:07easily just flowing through the
6:09eye but now let's talk about when this
6:11aqueous humor doesn't flow too great
6:13through the eye
6:14and it leads to increased intraocular
6:16pressure and we get damage to our optic
6:18nerve
6:19so first let's talk about open angle
6:21glaucoma so i pointed out these drainage
6:23angles
6:24and the drainage angle of the eye is
6:26formed
6:27with the cornea and the iris so hence
6:30it's a drainage angle it forms an angle
6:32between these two structures
6:34now in open angle glaucoma this angle
6:38is open so the aqueous humor
6:42can flow down to where it needs to go
6:44into the trabecular meshwork
6:46but the problem with open angle is not
6:49the drainage angle
6:50it's with the trabecular meshwork now i
6:53pointed out earlier
6:54to think of the mesh work as like a
6:56strainer because what happens is as we
6:59age
7:00this mesh work becomes less flexible
7:03it's less permeable it becomes thicker
7:05so it will become
7:07clogged so this aqueous humor cannot get
7:10through the trabecular meshwork
7:12and we get increased pressure and as you
7:14can see here
7:15when the trabecular mesh work is not
7:17working the fluid will start to collect
7:20in the eye and then you're going to get
7:22this increased pressure
7:24which is going to put pressure on that
7:26optic nerve and can cause
7:28vision damage so now let's talk about
7:30the signs and symptoms
7:31of open angle glaucoma well as i pointed
7:34out earlier the signs and symptoms are
7:36going to
7:36appear very subtly for that patient and
7:39whenever they actually notice
7:41like that tunnel vision where they're
7:42having that loss of that peripheral
7:44vision
7:44that means this disease has advanced so
7:47through early detection we can see some
7:49of these other signs and symptoms which
7:51lets us know that hey this patient may
7:52have open ankle glaucoma
7:54so really it's silent in its
7:56presentation and you may even
7:58hear it referred to as the thief of
8:00sight
8:01but typically these patients are not
8:02going to have pain with this type of
8:04glaucoma compared to
8:05angle closure glaucoma they're of course
8:08going to have increased
8:09intraocular pressure most patients will
8:12and
8:12this will be found through various
8:14readings now again how did we determine
8:16a patient's iop
8:18it was through a tonometer and whenever
8:22they
8:22look at the patient's drainage angles
8:24because you can look at the drainage
8:25angles through
8:26one of those eye exams they can use a
8:28gonioscope to assess that so that can
8:31tell us
8:31if they have angle closure or open angle
8:34and they may have what's called
8:36optic disc cupping and this can be
8:39assessed with an ophthalmoscope
8:41and you can look at the fundus of the
8:43eye
8:44and you can look at the optic disc to
8:46cup ratio
8:48and the optic disc is found on the
8:50fundus and in the middle of the disc
8:52is the optic cup so with chronic open
8:55ankle glaucoma the cup will become
8:57bigger compared to the disc and here
9:00on the right you will see a normal optic
9:03nerve
9:04notice the cup it's the bright part in
9:07the middle is smaller compared to the
9:09disc
9:09but here on the left the optic cup is a
9:12lot bigger compared to the disc now
9:14let's talk about angle closure glaucoma
9:16so again with these drainage angles we
9:18have the cornea and the iris and we have
9:21that angle
9:22and what's happened is that this angle
9:24has narrowed
9:25his hints close so this aqueous humor
9:28cannot get down into the trabecular
9:30meshwork into schlemm's canal and do its
9:32thing
9:33so we don't have a problem with
9:35trabecular's mesh work
9:36it's that this angle has closed off and
9:39what's going to happen is this aqueous
9:40humor is going to build up in
9:42on the eye and it's going to really
9:44severely
9:45hinder this optic nerve now when this
9:47type of glaucoma happens
9:49it is an emergency it's rare to happen
9:51but when it does it the person needs
9:53treatment immediately we're going to
9:54talk about those treatments a little bit
9:55later so what could cause this to happen
10:00well if a person already naturally has
10:03narrowed angles an anatomical defect
10:05that can cause it
10:06but medications can cause this that
10:08dilate
10:09that pupil because what it can do is it
10:11can push the lens or the iris forward
10:14and when you push that forward you close
10:16that angle
10:17and medication that can do that is like
10:20anticholinergics
10:21and you want to educate patients who are
10:23at risk for this to avoid those type of
10:24medications
10:25because you can get these like over the
10:27counter with like allergy medicines
10:28antihistamines
10:30or copd drugs or antidepressants so
10:34big risk with those now what are the
10:36signs and symptoms of this type of
10:38glaucoma
10:39well the patient is going to be able to
10:41notice them and they're not silent like
10:43with the other type of glaucoma
10:45so they can report severe eye pain
10:47they're going to have a lot of pain with
10:48this type of glaucoma
10:49they can also have nausea and vomiting
10:52they're going to have vision changes
10:53where their vision will be blurred from
10:55all that increased pressure
10:57when they look at lights they will see
10:59halos around the lights
11:00their eyes can be red the pressure can
11:03just be so high that it can cause
11:05edema on the cornea as you can see here
11:07in this picture
11:08and of course they're going to have very
11:10high iop
11:12now let's talk about the key concepts
11:13that you want to know about glaucoma as
11:16the nurse so to help us remember those
11:18key concepts we're going to remember the
11:19word
11:20thief so t is going to be about
11:22treatment goals
11:24and the treatment goal for the glaucoma
11:26of course is to reduce the
11:28intraocular pressure and this is going
11:30to help prevent
11:31damage to the optic nerve so medications
11:33are going to be the first line
11:35treatment for glaucoma most forms of
11:37medications are going to be in eye drops
11:39and
11:40patients can also receive oral meds and
11:42then surgical treatment can be provided
11:45and we're talking about like
11:46laser procedures or traditional eye
11:48surgery
11:49so first laser procedures a type of
11:51laser procedure that can be performed is
11:53called a selective laser
11:56trabeculoplasty also known as an slt
11:59and this procedure is relatively quick
12:01compared to the traditional eye
12:02surgery that we'll talk about next and
12:04it lowers the iop
12:06by using lasers to target certain parts
12:09of that drainage angle
12:10tissue which will cause changes to the
12:13tissue and these changes
12:14will allow that extra aqueous fluid to
12:17drain out of the eye and will decrease
12:20iop now a thing about this is that the
12:23iop
12:24will be lowered over several months and
12:26it's not a permanent
12:28solution next is a more traditional type
12:31of eye surgery and it's typically
12:33performed
12:34when they can't decrease intraocular
12:37pressure in the eyes
12:39because eye drops or other procedures
12:41are not working so a common type of
12:43traditional eye surgery is called a
12:44trabeculectomy
12:46and this is where some of the trabecular
12:48mesh work is removed and an opening is
12:50created to allow aqueous humor to
12:52collect
12:53in an area of the conjunctiva and
12:56this fluid will be reabsorbed and it
12:58will decrease
12:59iop now the patient whenever they have
13:02this procedure will have what's called a
13:04bleb
13:05and you can see that in this picture
13:07here we're pointing to the bleb in
13:09yellow and that is usually going to be
13:11found under
13:12the upper eyelid and this is where that
13:14fluid has collected now important thing
13:17to remember
13:17about these procedures is that vision
13:19that is lost already will not come back
13:22these procedures are going to help
13:23control pressure for several years
13:25and they are not permanent now let's
13:27talk about the post-op education for a
13:29patient who's had glaucoma surgery and
13:32things you need to know as the nurse
13:33so it's very important that you tell the
13:35patient that it's important that they go
13:38to
13:38all of their post-op appointments
13:40because here the doctor is going to be
13:42measuring their eye pressure and looking
13:44at other important post-op
13:45assessments also they don't need to be
13:47driving until they've been cleared by
13:49their doctor
13:50and if they have to go out in direct
13:52sunlight they need to wear protective
13:54sunglasses
13:56also they need to know how to instill
13:58eye drops which we're going to talk
13:59about a little bit later
14:00and to do it exactly as prescribed don't
14:03skip drops
14:05um do some here do some another day it
14:08needs to be exactly how the physician
14:09has ordered it because they're going to
14:10be taking antibiotics
14:11anti-inflammatories etc
14:13and to always use clean hands whenever
14:15they do this plus you need to tell the
14:17patient to refrain from rubbing their
14:18eyes
14:19because they may feel itchy after the
14:21procedure if they have stitches
14:24and they don't want to use their contact
14:26lenses and they want to avoid
14:28activities that increase eye pressure so
14:30you want to make sure that your patient
14:32isn't bending or doing straining
14:34activities like reading
14:36or even straining during a bowel
14:38movement because sometimes patients get
14:40constipated
14:41and they may need stool softeners during
14:43this time because we do not want them
14:45straining to get stool out because this
14:46increases their iop
14:48or lifting heavy objects furthermore you
14:51want to tell them that they need to wear
14:52their eye
14:53shield as prescribed and they may have
14:57blurred vision
14:58their eyes may tear up more frequently
15:00and their eyes may feel itchy
15:02this is normal after the procedure and
15:04this will decrease over time
15:05also they need to report any sudden
15:07vision loss or severe pain
15:09and some pain is common because they've
15:11just had surgery on their eye
15:13and it's very vital they monitor for
15:15infection like any
15:16abnormal discharge a fever extreme eye
15:20redness they can have some
15:22but any extreme or any extreme vision
15:25changes but again blurred vision
15:27at first is normal then we have h for
15:29helpful to remember the three s's
15:31of open angle glaucoma so you definitely
15:34want to know the differences
15:35between open angle and angle closure so
15:38the three s's for open
15:40angle is silent sight stopper so
15:43silent represents the patient's going to
15:45be asymptomatic
15:46until it's too late because the
15:49irreversible damage has been done to
15:51that optic nerve
15:52when the patient actually notices the
15:54loss of peripheral vision
15:55and they have that tunnel vision next is
15:58size so the vision loss can't be brought
16:00back and once blindness occurs it's
16:02permanent and
16:03why does it occur because we've had
16:05increased intraocular pressure that has
16:07damaged
16:08that optic nerve and then the last s
16:10stopper so the development of permanent
16:12vision loss
16:13blindness is stoppable hence it's
16:15avoidable if glaucoma is identified
16:17early through an eye exam that checks
16:19for eye pressure
16:21so let the patient know about this
16:23especially the patients who are at risk
16:25for glaucoma which we're going to talk
16:26about a little bit later
16:28and we can prevent the loss of vision
16:30through medications or procedures that
16:32help keep the iop low
16:34next is eye for immediate treatment for
16:36angle closure glaucoma
16:38so remember this is an emergency and
16:40this is not
16:41a type of glaucoma that's going to be
16:43silent with its signs and symptoms
16:45and medications can be used to lower
16:47that iop like eye drops or oral
16:49medications
16:50along with a surgical procedure like a
16:53laser iridotomy and this is where a
16:56small hole is created in the iris with a
16:59laser to drain that extra aqueous humor
17:02also a more traditional surgery could be
17:05an aerodyctomy and this is where they
17:07remove
17:08parts of the iris and remember the iris
17:10is that colored part of the eyes
17:12so look at those eyeballs it's the green
17:14part and this may be performed in both
17:16eyes because there is a risk of both of
17:18those eyes
17:19actually developing angle closure
17:22glaucoma so they can do that as a
17:23preventative measure
17:24next is e for eye drop so now we're
17:27going to talk about how to administer
17:28eye drops to a patient and i have a
17:30whole video a link should pop up in the
17:32corner
17:33where i actually demonstrate how to do
17:35this but i'm going to go over the
17:36highlights that you need to know
17:38and then we're going to go into the
17:39different types of medications
17:41so first you want to tell the patient
17:43that they don't want to skip days or
17:45abruptly stop
17:46taking the eye drops so some of these
17:49patients they have
17:50quite a few eye drops to take and they
17:52have to take them throughout the day
17:53so it can be hard getting into that
17:55routine and
17:57you want to stress to the patient that
17:59it's very very important that they
18:01take these eye drops exactly as
18:02prescribed because if they skip days
18:04and don't take them here or there they
18:07are ultimately
18:08risking losing their vision because
18:10these drops are made to help
18:11lower their iop also you want to stress
18:14the importance of always washing your
18:16hands before instilling eye drops
18:18because that is one of the big ways we
18:20get sick whenever we
18:22use our hands you know we're touching
18:24surfaces that have
18:25bacteria viruses in them if we touch our
18:28eyes
18:28with those hands we just transfer that
18:31virus or
18:32bacteria into our eye so always use
18:35clean hands when doing this
18:36next is about administering more than
18:38one type of eye drop medication
18:41so as a nurse this is important you know
18:42this and for the patient who's going to
18:44be instilling these at home
18:46so the rule of thumb is to space out
18:48each type of eye drop that the patient
18:50has to take
18:51about three to five minutes so let's say
18:53your patient has two eye drops they need
18:55to take
18:56so they'll take the one eye drop
18:58medication as prescribed and then they
19:00need to wait at least three to five
19:02minutes before instilling the other type
19:04of medication and why do we do this well
19:08we want that first medication to have
19:10time to work to
19:12be in the eye and if we quickly gave
19:14that second
19:15type of eye medication it would just
19:17wash out the first
19:19so you definitely want to have that time
19:22frame between
19:23the types of eye drops and then let's
19:25say your patient has an eye ointment
19:27ordered and an eye drop which one are
19:29you going to give first
19:30you will give the eye drops first and
19:32then you will give the eye ointment
19:34so whenever you give your patient those
19:36eye drops how do you
19:37instill them in the eye well you're
19:39going to place each drop
19:41on the lower sack of the eye and you can
19:43see this sack
19:44here in this picture on the right this
19:46is called the conjunctival sac
19:48you will not directly put the eye drop
19:51on the cornea
19:52via the eye now after instilling each
19:55eye drop medication you want to have the
19:56patient refrain from blinking
19:59but to keep the eye closed and to
20:01perform punctal occlusion
20:03so to do this you will have the patient
20:06or you
20:06use your index finger and gently place
20:09pressure at the side of the bridge of
20:11the nose over
20:13the lacrimal punctum and you can see
20:15that at the top pitcher that's an up
20:17close picture of it
20:18and you'll do this for about two to
20:20three minutes now why
20:22are we doing this well this is to
20:24prevent the medication you just gave
20:26them in their eye
20:27from draining down into the nasolacrimal
20:30duct and being absorbed by the blood
20:33which can cause
20:34widespread signs and symptoms so if you
20:36gave this patient
20:38a commonly prescribed glaucoma
20:40medication like a beta blocker
20:41or a cholinergic eye drop if we didn't
20:45perform this punctal occlusion
20:47that medication that's supposed to stay
20:49in the eye to do its job
20:50can drain down through this tear duct
20:54and can enter into the blood and
20:55actually cause those signs and symptoms
20:57of those medications and we don't want
20:59that to happen
21:00so now let's talk about those
21:01medications so how do medications work
21:04well they're going to help
21:05lower our iop and they're going to do it
21:08one of two ways or both ways they're
21:10going to decrease production of the
21:12aqueous humor
21:14and or they're going to increase the
21:16drainage of the aqueous humor so this is
21:18great we're going to get lower
21:19intraocular pressure so to help us
21:22remember some of these drugs because
21:24there's
21:24quite a few we're going to remember the
21:27abcs so that's going to help us remember
21:29four of them
21:30so first a for alpha agonist and these
21:33tend to end
21:34in i-d-i-n-e like brymotidine
21:37and these work with alpha receptors by
21:40activating them so we'll get the
21:42decrease of aqueous humor production
21:45because it constricts the ciliary body
21:47remember that producer aqueous humor
21:50and this helps increase the drainage of
21:52aqueous humor out of the eye
21:54and lowers our iop now remember this can
21:57cause
21:58systemic effects so we need to do
22:00punctal occlusion
22:01and one side effect that some patients
22:03can have is that they can feel very
22:05drowsy after taking this next is b for
22:08beta blockers and they
22:09end in o l o l like timolol
22:12and these decrease aqueous humor
22:14production and they can cause those
22:16systemic effects majorly so punctual
22:18occlusion very vital
22:20there's different types like
22:21cardio-selective and
22:23non-cardio-selective
22:24and they are not for patients with
22:26bradycardia
22:27asthma or copd and we talked in depth
22:30about this
22:31whenever we talked about our beta
22:32blocker video which you can access
22:34up here in the right corner if you want
22:36to watch that so with this you want to
22:38assess a patient's breathing and heart
22:40rate before administration
22:42then we have c for carbonic anhydrase
22:45inhibitors
22:46and they end in z-o-l-a-m-i-d-e
22:49so zolamides and they can be ordered
22:52orally or via drops
22:54and one medication type is called
22:56acetylzolamide
22:58and these decrease aqueous humor
23:00production so they're like diuretics
23:01that inhibit carbonic acid production
23:04now you want to assess the patient's
23:06allergies because if they have a
23:08sulfonamide allergy they cannot take
23:10these medications
23:12and then our last c is for cholinergics
23:15and these are meiotics and one type is
23:17pilocarpine and how this works is it
23:20helps lower the iop
23:21by constricting the pupil because that's
23:23what these drugs do
23:25and this will help increase the drainage
23:28of aqueous humor
23:29out through that trabecular meshwork now
23:31it's important to be familiar
23:33with the antidote for these drugs which
23:35is atropine
23:36and these drugs can cause that
23:39cholinergic effects like
23:40sweating increased elevation
23:42bronchospasm decreased heart rate
23:44and increase the eye sensitivity with
23:47light
23:48so they may have problems with vision
23:50and dim light
23:51and again it's very important that they
23:53perform punctual
23:54occlusion whenever they take this
23:56medication some other drugs include
23:58a prostaglandin analogues and they end
24:01in pros
24:02like bomatopose and these increase the
24:05drainage of aqueous humor out the eyes
24:07and they don't tend to cause as many
24:09systemic effects as those other
24:10medications that we just went over
24:12but an interesting side effect of this
24:15medication and depends on
24:17if you like this or not it can actually
24:19cause
24:20thicker and longer eyelashes and i have
24:22actually
24:23seen this in a patient it was an older
24:26patient
24:27and their eyelashes were the most
24:28beautiful eyelashes i've ever
24:30seen and i didn't think they were real
24:33and
24:34i looked in their history and they in
24:36fact were taking this medication for the
24:38treatment of glaucoma
24:40and another change that this medication
24:42can cause is that they can change the
24:44color of the iris
24:46to a brown color and then lastly we have
24:48rokinase inhibitors and these
24:50medications are relatively
24:52new for the treatment of glaucoma and
24:55a medication they have is called
24:57natarsadil
24:58and this increases the drainage of
25:00aqueous humor by inhibiting the rock
25:03pathway and this pathway is actually
25:05found in the trabecular mesh work
25:07so it will cause the mesh work to drain
25:09better because remember we talked about
25:11that this mesh work
25:12becomes stiff and it doesn't work very
25:14well
25:15so it'll start to drain and this will
25:17help decrease iop
25:19now one thing that this medication can
25:21cause because it causes dilation
25:23is that it can cause the eyes to become
25:25extremely
25:26red and then the last part of our
25:28mnemonic is f for factors that
25:30increase the development of glaucoma so
25:32to help us remember those risk factors
25:34remember the word save and we're talking
25:36about
25:36save your eyesight so s is for 60 or
25:39older especially if they have a family
25:41history
25:42a is for african american hispanic or
25:44asian community these people
25:46are at risk for glaucoma v for vascular
25:49problems such as like with diabetes
25:51hypertension
25:52and then e for elevated intraocular
25:55pressure because remember
25:56generally that normal iop was 10 to 21
25:59millimeters of mercury
26:01so if they have these risk factors it's
26:03very important that they go for those
26:04eye exams
26:05so they can try to detect if the iop is
26:08elevated
26:08okay so that wraps up this review over
26:11glaucoma and don't forget to access that
26:13free quiz that will test you
26:14on this material