Glaucoma vs Cataracts on the NCLEX
Open vs closed angle, eye drop teaching, and the post-op cataract rules.
Both steal vision, by opposite mechanisms: pressure on the optic nerve vs a clouded lens.
Open-angle glaucoma
The common, sneaky form. Aqueous humor drains too slowly, IOP creeps above the normal 10-21 mmHg, and the optic nerve slowly dies. Painless, gradual loss of PERIPHERAL vision first (tunnel vision). Central vision goes last, so patients notice late. Screening tonometry catches it.
Angle-closure glaucoma is an emergency
The drainage angle closes suddenly. Severe eye pain, headache, halos around lights, blurred vision, a red eye, nausea and vomiting, and a fixed mid-dilated pupil. IOP must come down within hours to save vision: IV agents per order, then laser iridotomy. Never give mydriatics or anticholinergics to these patients; dilating the pupil closes the angle further.
Glaucoma drop teaching
Drops are lifelong, even when vision feels fine; lost vision never comes back, drops only stop the loss. Prostaglandin analogs (latanoprost): may permanently darken the iris and thicken lashes. Beta-blocker drops (timolol): systemic absorption can slow the heart and tighten airways, so caution with bradycardia, heart block, and asthma or COPD. Teach punctal occlusion: press the inner corner of the eye for a minute after instilling to limit systemic absorption. Wait about 5 minutes between different drops.
Cataracts and the post-op rules
A cataract is a clouded lens: painless, gradual blurring, glare at night, faded colors. The only fix is outpatient surgery with lens implant. Post-op teaching: wear the eye shield at night, glasses or shield by day; avoid anything that spikes IOP: bending at the waist, lifting, straining at stool, vigorous coughing; do not rub the eye; give the drops as prescribed. Report sudden pain, sudden vision loss, or a curtain over vision (hemorrhage, infection, retinal detachment). Vision sharpens gradually over days to weeks.
Frequently asked
Which glaucoma presents to the ED?
Angle-closure. Sudden painful red eye with halos and vomiting. Open-angle is silent for years.
Cataract post-op patient asks about resuming bowling. Priority teaching?
Not yet. Lifting and bending raise IOP and stress the surgical eye. Ask the surgeon when activity can resume.
Quick check
Loading a question…
How ready are you right now?
10 real NCLEX questions, free, in your browser. See how close you are to ready and which subjects are costing you.
Try 10 questions free