Possibly evidenced by
Reported change in sensory acuity—photosensitivity, visual distortions, progressive loss of visual field; measured change in sensory acuity
Desired Outcomes/Evaluation Criteria—Client Will
Sensory Function: Vision
Maintain current visual field and acuity without further loss.
Risk Control: Visual Impairment
Participate in therapeutic regimen.
Follow prescribed medication regimen.
Nursing intervention with rationale:
1. Ascertain type and degree of visual loss.
Rationale: Affects choice of interventions and client’s future expectations.
2. Encourage expression of feelings about loss or possibility of loss of vision.
Rationale: Although early intervention may prevent blindness, client faces the possibility of or may have already experienced partial or complete loss of vision. Although vision loss cannot be restored (even with treatment), further loss can be prevented.
3. Recommend measures to assist client to manage visual limitations and provide safety, including reducing clutter, arranging furniture out of travel path, turning head to view subjects or objects, correcting for dim light, and problems of night vision.
Rationale: Reduces safety hazards related to changes in visual fields or loss of vision and papillary accommodation to environmental light.
4. Explain the importance of medication administration as ordered by the physician.
Rationale: Proper understanding may increase the client’s motivation and participation in treatment plan.
5. Demonstrate and have client or significant other (SO) administer eye drops using correct procedures—placement of drop, counting drops, adhering to schedule, and not missing doses.
Rationale: Although burdensome, lifelong treatment is needed to control IOP and prevent further loss of vision.
6. Miotics, also called cholinergic agonists: for example, pilocarpine (Isopto Carpine, Ocusert, Pilopine HS gel)
Rationale: These drugs cause pupillary constriction, facilitating the outflow of aqueous humor and lowering IOP. Note: Ocusert is a disc (similar to a contact lens) that is placed in the lower
eyelid, where it can remain for up to 1 week before being replaced.
7. Anticholinesterase miotics: for example, demecarium (Humorsol), echothiophate (Phospholine Iodide), and isoflurophate (Floropryl)
Rationale: These drugs are used for management of glaucoma not controlled with short-acting miotics. Note: Because of their potential for serious side effects, some authorities prefer
surgery rather than use of the drugs (Glaucoma Research Foundation, n.d.).
8. Beta-blockers: for example, timolol (Timoptic), betaxolol (Betoptic), levobetaxolol (Betaxon), and carteolol (Ocupress)
Rationale: These drugs decrease 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.
9. Carbonic anhydrase inhibitors: for example, brinzolamide (Azopt) and dorzolamide (Trusopt)
Rationale: These drugs decrease the amount and rate of production of aqueous humor. Note: Systemic adverse effects are common, including mood disturbances, gastrointestinal
(GI) upset, and fatigue.
10. Prostaglandin agonists: for example, bimataprost (Lumigan), Latanaprost (Xalatan), and travaprost (Travatan)
Rationale: Drugs in this class are commonly prescribed drops for increasing outflow drainage of aqueous humor. Note: May be preferred over beta-blockers because of lesser degree of systemic affect; however, may cause more redness of the eye than other drugs.