Lily Miller Ocular hypertension will be examined in greater detail in this article, along with its causes and treatments.
Ocular hypertension is when the pressure inside the eye (intraocular pressure or IOP) is higher than usual. Ocular hypertension results in improper fluid drainage from the front of the eye. As a result, eye pressure increases.
Glaucoma may be brought on by excessively high eye pressure. Eye pressure damage from the disease known as glaucoma results in loss of vision.
Please read on.
Table of Contents
What is Ocular Hypertension?
Ocular hypertension occurs when the intraocular pressure—also known as eye pressure—is excessively high but there are no symptoms of glaucomatous damage. It may affect one or both eyes.
It is normal to have an intraocular pressure of 11 to 21 millimeters of mercury (mmHg).
A person is said to have intraocular hypertension when:
- intraocular pressure is consistently elevated above 21 mmHg
- there’s an absence of clinical signs of glaucoma, such as optic nerve damage or a reduced field of vision
Ocular hypertension can harm the optic nerve, so having high eye pressure may make you more susceptible to glaucoma. However, glaucoma does not always result from ocular hypertension.
Ocular Hypertension Causes
One of the main risk factors for glaucoma, elevated intraocular pressure is a concern in those with ocular hypertension.
The production and drainage of the eye’s fluid, known as aqueous humor, are out of balance, which results in high pressure inside the eye. The channels that normally allow fluid from the inside of the eye to drain are not working properly. More fluid is continuously produced, but because the drainage channels are not working properly, it cannot be drained. The pressure in the eye increases as a result of the increased fluid content.
An additional way to visualize high pressure in the eye is to visualize a water balloon. The pressure inside the balloon increases with the amount of water added. The same issue arises when there is an excessive amount of fluid inside the eye; the more fluid present, the greater the pressure. Additionally, excessive pressure may harm the eye’s optic nerve, just as it can cause a water balloon to burst if it is filled with too much water. Those who have normal, very thick corneas frequently have eye pressure readings that are at or slightly above the high levels of normal . Although their pressures may be lower and normal, the thick corneas make measurements give a falsely high reading.
Ocular Hypertension Symptoms
Ocular hypertension is typically asymptomatic. In order to rule out any optic nerve damage from the high pressure, routine eye exams with an eye doctor are crucial.
Who is at Risk for Ocular Hypertension?
Ocular hypertension is a condition that anyone can get, but some people are more prone to it than others. They include:
- those with family history of ocular hypertension or glaucoma
- people who have diabetesor high blood pressure
- people over age 40
- African-Americans and Hispanics
- people who are very myopic (nearsighted)
- people who take long-term steroid medications
- people who have had eye injuries or surgery
- those with pigment dispersion syndromeor pseudoexfoliation syndrome (PXF)
How is Ocular Hypertension Diagnosed?
Your ophthalmologist will measure the pressure in your eye. You apply eye drops to numb your eye before the test. Your doctor measures how well your cornea deflects light pressure using a device known as a tonometer. Your eye pressure is calculated using this.
A glaucoma test will be performed by your ophthalmologist as well. They will examine your optic nerve for signs of damage, and check your side (peripheral) vision.
When to Seek Medical Care
Questions to Ask the Doctor
- Is the pressure in my eyes increased?
- Exist any indications of internal eye damage brought on by a trauma?
- Are there any abnormalities with the optic nerve on my exam?
- Is my side vision typical?
- Is medical care required?
- How frequently should I have additional testing?
Exams and Tests
Measurement of intraocular pressure as well as tests to rule out primary open-angle glaucoma in its early stages as well as secondary glaucoma causes are both done by an eye doctor. The explanations for these tests are provided below.
- Your ability to see an object clearly is initially measured by your visual acuity. By having you read letters on an eye chart from across the room, your eye doctor can assess your visual acuity.
- A slit lamp is a unique type of microscope used to examine the front of your eyes, including the cornea, anterior chamber, iris, and lens.
- Measurement of the pressure inside the eye is done using tonometry. At least 2-3 measurements are made for each eye. Measurements may be made throughout the day (e.g., between 8:00 a.m. and 5:00 p.m.), as intraocular pressure varies from hour to hour in every individual., morning and night). Glaucoma may be indicated by a 3 mm Hg or greater pressure difference between the two eyes. It is very likely that you have early primary open-angle glaucoma if the intraocular pressure is consistently rising.
- To ensure a thorough examination of the optic nerves, each one is checked for any damage or abnormalities; this may require dilation of the pupils. Fundus photographs—pictures of the front surface of your optic nerve, or your optic disk—are taken for future use and comparison.
- A special contact lens is placed on the eye during a gonioscopy procedure to examine the drainage angle of your eye. This examination is crucial to determine whether the angles are open, narrowed, or closed and to rule out any other conditions that might result in an increase in intraocular pressure.
- An automated visual field machine is typically used in visual field testing to evaluate your side or peripheral vision. This examination is carried out to rule out any glaucomatous visual field defects. Repeated visual field testing might be necessary. Only once a year of the test may be necessary if there is a low risk of glaucomatous damage. The test may be conducted up to every two months if there is a high risk of glaucomatous damage.
- The accuracy of your intraocular pressure readings is evaluated using pachymetry, also known as corneal thickness, by an ultrasound probe. While a thick cornea can read pressures that are falsely high or low, a thinner cornea can do the opposite.
How is Ocular Hypertension Treated?
Prescription eye drops are used to treat ocular hypertension. These drops either promote the drainage of aqueous humor from the eye or reduce the amount that is produced. Some examples are:
- prostaglandins (travoprost, latanoprost)
- rho kinase inhibitors (netarsudil)
- nitric oxides (latanoprostene bunod)
- beta blockers (timolol)
- carbonic anhydrase inhibitors (dorzolamide, brinzolaminde)
Your eye doctor will probably plan a follow-up appointment a few weeks later to check on the effectiveness of the eye drops.
It’s also crucial to follow up with your eye doctor every one to two years for an eye exam because ocular hypertension raises the risk of developing glaucoma.
Your eye doctor may decide to monitor your intraocular pressure without using prescription eye drops if it is only slightly elevated. They may then suggest prescription eye drops if it stays elevated or increases.
Surgery for Ocular Hypertension
Opioids may not work well for all patients with ocular hypertension. Surgery might be advised in this situation to assist in reducing intraocular pressure.
Surgery for ocular hypertension aims to make a passageway for extra aqueous humor to exit the eye. A laser or more conventional surgical methods can be used for this.
Next Steps Follow-up
People with ocular hypertension may need to see a doctor every two months to yearly, or even sooner if the pressures are not being adequately controlled, depending on the degree of optic nerve damage and the level of intraocular pressure control.
People with elevated intraocular pressure, normal-appearing optic nerves, and normal results from visual field testing should still be on the lookout for glaucoma, as should those with normal intraocular pressure, suspicious-appearing optic nerves, and abnormal results from visual field testing. Due to their elevated risk of developing glaucoma, these people should be closely monitored.
Prevention
Ocular hypertension cannot be stopped, but its development into glaucoma can be stopped by getting regular eye exams from an eye doctor.
Medications
The ideal drug for treatment of ocular hypertension should effectively lower intraocular pressure, have no side effects, and be inexpensive with once-a-day dosing; however, no medicine possesses all of the above. Your eye doctor considers these factors along with your unique needs when selecting a medication for you.
To help lower elevated intraocular pressure, medications, typically in the form of medicated eyedrops, are prescribed. It is occasionally necessary to take multiple medications.
Your eye doctor might recommend using the eyedrops in just one eye at first to gauge how well the medication lowers intraocular pressure. If it works, your doctor will probably instruct you to apply the eyedrops to both eyes. Check out How to Instill Your Eyedrops.
You visit your eye doctor on a regular basis for checkups after receiving a prescription for medication. Usually 3–4 weeks after starting the medication, the patient has their first checkup. To make sure the medication is assisting in lowering your intraocular pressure, your pressures are measured. If the medication is effective and not having any negative side effects, it is continued, and 2-4 months later, you are evaluated again. You will stop taking the medication and be prescribed a new one if it is not lowering your intraocular pressure.
Your eye doctor keeps an eye on you at these subsequent appointments to check for any drug allergies. Be sure to let your eye doctor know if you experience any side effects or symptoms while taking the medication.
In general, early primary open-angle glaucoma may occur instead of ocular hypertension if the pressure inside the eye cannot be reduced with 1-2 medications. In this situation, your eye doctor will go over the best course of action for your treatment.
Outlook
Ocular hypertension patients have a very positive outlook.
- Most people with ocular hypertension do not develop primary open-angle glaucoma and maintain their good vision throughout their lifetimes with careful follow-up care and adherence to medical treatment.
- The optic nerve and visual field may continue to change with inadequate management of elevated intraocular pressure, which may eventually cause glaucoma.
The Bottom Line
Ocular hypertension is when your eye pressure is higher than normal but there are no symptoms of glaucomatous damage. It may occur if the fluids your eye naturally produces don’t drain properly.
Optic nerve damage from ocular hypertension is a possibility. Ocular hypertension puts a person at a higher risk of getting glaucoma as a result.
You probably won’t be aware that you have ocular hypertension because it rarely has symptoms. Routine eye exams can aid in the early detection and treatment of ocular hypertension before any damage or vision loss is done.
