Earliest sign of glaucoma is

OSSSC Nursing Officer-2021

Medical & Surgical Nursing

Hard

Appeared in: OSSSC Nursing Officer-2021

Explanation

Halos around lights are a classic early symptom of glaucoma, particularly the angle-closure type.
This symptom is caused by corneal edema (swelling of the cornea) resulting from a sudden and significant increase in intraocular pressure (IOP).
The corneal swelling scatters light entering the eye, creating the perception of rainbow-like circles or halos around sources of light.
While the most common form (open-angle glaucoma) is often asymptomatic initially, halos are a key reported symptom that indicates a serious, acute problem.

Option A: Double vision (diplopia) results from a misalignment of the eyes, which is not a feature of glaucoma. Glaucoma affects the optic nerve due to high pressure inside the eye.
Option C: Although blurred vision occurs in glaucoma (especially angle-closure), it is a very non-specific symptom. Many conditions, such as uncorrected refractive errors, cataracts, or dry eye, can cause blurred vision.
Option D: Headache is a major symptom of acute angle-closure glaucoma but not of the much more common open-angle glaucoma. In the acute form, it is typically severe and accompanied by eye pain, nausea, and vomiting, rather than being an isolated early sign.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Early signs and symptoms of glaucoma as background academic context rather than a clinical decision trigger.
The presentation of halos around lights, especially with eye pain, is a sign of acute angle-closure glaucoma, which is a medical emergency. A nurse must recognize this and ensure the patient receives immediate ophthalmological care to prevent permanent blindness.
Nurses play a key role in educating the public, particularly high-risk groups (e.g., adults over 40, individuals with a family history of glaucoma), about the importance of regular comprehensive eye exams for early detection of silent open-angle glaucoma.
What if? If a patient reports a slow, painless loss of side vision (peripheral vision) over several months, the most likely diagnosis is open-angle glaucoma. This presentation requires a routine ophthalmology referral, not an emergency response like the one for halos and eye pain.

How to Approach the Question

Step 1: Identify the core of the question, which asks for the 'earliest sign' of glaucoma.
Step 2: Recall that glaucoma has two main forms with different presentations: open-angle (slow, silent) and angle-closure (can be acute, symptomatic).
Step 3: Evaluate the options. 'Double vision' is not a primary symptom. 'Blurred vision' and 'headache' are possible but are non-specific.
Step 4: Recognize that 'halos around lights' is a hallmark symptom caused by corneal edema from high intraocular pressure, a key event in angle-closure glaucoma. This makes it the most distinct and alarming early symptom among the choices.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 96-98

E6 Medicine Davidson Principles Practice 24e p. 1190-1192