Synopsis
Measure and document intraocular pressure safely, recognise method-related uncertainty and interpret the result alongside symptoms, optic-nerve structure, fields and anterior chamber anatomy.
- Intraocular pressure is a risk factor and treatment target, but one pressure value does not diagnose or exclude glaucoma.
- Use Goldmann-type applanation measurements in the NICE glaucoma referral assessment; do not refer solely on an air-puff result.
- Before measurement, consider trauma, corneal ulceration, recent surgery, device suitability and the safety of corneal contact.
Key red flags
Severe ocular pain with nausea, vomiting, reduced vision or a cloudy cornea requires emergency assessment even when a reliable pressure reading is unavailable.
Investigation priorities
Provide the pressure measurement used in the NICE referral assessment.
Management branches
Pressure measurement is indicated and the clinical setting permits assessment.
- Review ocular injury, surgery and surface disease, inspect for contraindications and choose a suitable measurement method.
- Confirm the instrument and tip are appropriate, calibrated and prepared under current infection-control and manufacturer instructions.
Key medicines
Minims proxymetacaine hydrochloride 0.5% eye dropsFor tonometry, instil one or two drops topically into the eye immediately before measurement, then stop after the procedure and discard the single-use unit. Allow at least one minute before administering another topical agent such as fluorescein.