Friday, March 25, 2011

Explaining Interoccular Pressure (Update Included)

Brief update: Anna had an appointment with the ophthalmologist yesterday. Routine results: still a trace of cells in the left eye; right eye clear. I'm thinking maybe this is normal for Anna. Still on one Pred Forte drop per day to the left eye and all the same medications. Anna's "pressures" are always checked before we leave the office. The nurse (or assistant---whomever she may be) made faces when she looked at the numbers. The first number (right eye) was 22; the first left eye number was 21. She took them again with results of 21 and 19. Not the best pressure numbers Anna has ever had. However, the nurse/assistant checked with the doctor before she let us leave, and I guess he didn't have a problem with them, because he didn't have her check them again, and we go back in six weeks.

Anna was wondering exactly what are the "pressures" which they measure. I tried to explain it, although it's been quite a few years since I researched and read everything I could. So today I sat down and "googled" to find an explanation for her (and anyone else who might be interested). The website at says:

"Intraocular pressure is a measurement of the fluid pressure inside the eye. This fluid, or aqueous humor, nourishes the cornea, iris, and lens, and it helps the eye maintain its globular shape. The typical eye produces about 4 c.c. of fluid a day, which is circulated and then drains out of the eye.

What causes intraocular pressure?
If the drainage system becomes clogged or if too much fluid is produced, pressure inside the eye can build up. The reasons for buildup are not fully understood.

Increased intraocular pressure can also result from the use of topical steroid eye drops such as those used in the treatment of an inflammation within the eye. Although these medications may be necessary in the treatment of the disease, they can cause a temporary elevation of intraocular pressure.

Normal eye pressure, as measured by an eye doctor, usually ranges between 10 and 21 mm of mercury, with an average of 16. Physical activity, stress, rapid fluid intake, and caffeine can account for a small plus or minus change in an intraocular pressure reading. Pressure that is consistently above 21 indicates ocular hypertension. The condition can develop into glaucoma, a serious disease that causes damage to the optic nerve. Because glaucoma is the leading cause of blindness among adults in the United States, early detection and treatment are key to preventing serious loss of vision or blindness.

How is intraocular pressure measured?
Intraocular pressure is measured with an instrument called a tonometer. There are two types of tonometers, but the most accurate is considered to be the applanation tonometer, an instrument that looks like a pen. After numbing eye drops are administered, the instrument is applied gently to the front surface of the eye and provides a pressure reading. The other type of tonometer is a noncontact tonometer, which directs a warm puff of air toward the eye without touching it."

Since I'm a visual learner, I thought I would also include some images (seen above, obviously): one of uveitis (what the ophthalmologist sees with the slit lamp exam---although this image is a much more severe case of uveitis than Anna has), and one showing the effects of increased interoccular pressure (Anna's are really just on the borderline of being normal, though, so no worries at this time).


Anonymous said...

Thank you. We just has 20 for the first time (16 or less before) so I am/was very nervous. BR, Kate

Anonymous said...

Please read this :-):

Ocular pressure may increase as uveitis resolves

As the uveitis gets better, the eye often starts to produce more fluid before the inflammation decreases sufficiently in the eye's drainage system. When the pressure rises as the uveitis is going away, there might be a temporary imbalance between how much fluid is being produced and how much the drainage network of the eye can handle.
When uveitis gets worse, the amount of fluid produced usually decreases (which helps keep the ocular pressure at safe levels). Ocular pressure tends to rise in the presence of steroids.

BR, Kate

Tammy Z said...

Kate---I also get a little nervous when I hear any number that is 20 or more. You're not alone! :o) Thanks for the little paragraph about the ocular pressure. Very interesting!!! I don't research as much as I used to (don't have as much time to do so these days). :o)

Anonymous said...

Last Friday IOP 24 on 2x maxidex, but today after week of 2x Trusopt and replacing Maxidex 2x with Vexol 1x, IOP 15 again, so rise was because of Maxidex. Thanx God for today exam and thank you Tammy for writing about pressure. Please keep writing about Anna, she is our star :-) Kate

Tammy Z said...

Thanks, Kate! :o)