Update: November 2018
The external pressure (IOP) ensures the maintenance of a round
the shape of our eyes. Норма его поддерживается на уровне 10 –
21 мм р.с. If this figure is higher, they talk about
ophthalmic hypertension. О симптомах elevated глазного давления и
its treatment further.
Types of high IOP
- Symptomatic or secondary eye pressure occurs on
background of various diseases – hypertension, sugar
diabetes, thyroid dysfunction, some diseases
eye taking medication.
- Essential or primary. Occurs in people after 40 years on
the background of age-related changes and violations of intraocular outflow
По степени возactions на структуры глаза:
- Ophthalmic hypertension. Only high pressure is noted, often
asymptomatic, changes in the fundus is not observed. Risk
development of glaucoma.
- Glaucoma. it более тяжелая степень офтальмогипертензии с
irreversible changes of the optic nerve head, in violation of
acuity and loss of visual fields.
- Episodic. This may include a short-term increase
intraocular pressure in healthy people in the face of stress,
физического напряжения, избыточного употребления fluid.
- One way.
By degree of increase
- Нормальное – до 21 mm RS
- Haveмеренно повышенное — до 28 мм р.с.
- High – above 28 mm RS
Why does it go up
- Excessively high production of intraocular fluid (after
wounds of the eyeball, antiglaucomatous operations)
- Poor drainage from the anterior chamber (degeneration of the ciliary body,
inflammation, dull eye injury).
- Some medications (long-term steroid use
- Eye injuries.
- Significant decrease in blood pressure (blood pressure).
- Other diseases of the eye (sluggish uveitis of any etiology).
- Diabetic coma.
Measurement of eye pressure (tonometry) is mandatory at
routine examination at the ophthalmologist of persons from the age of 40
There are many methods of tonometry. But in clinical
practice using indirect methods. The basic principle of such
measurements – the definition of the response of the eye to the attached to it
An experienced doctor can evaluate it without tools – by
resistance to the eyeball when pressed on it
with your fingers.
But most often two methods are used:
Based on measuring the degree of flattening of the cornea at
imposing a weight on it weighing 10g. The method is simple enough
reliable, and is used both for routine inspections and for
control treatment in glaucomatous patients. When measuring intraocular
pressures in this way speak of tonometric pressure, and
нормальные значения при этом получаются несколько выше
(the norm is the figure up to 25 mm RS).
it измерение уплощения роговицы при воздействии на нее потоком
compressed air. The method is less reliable, but the primary one is quite suitable.
identify high IOP.
In addition to high, low eye pressure can also occur.
(hypotension of the eye). At the same time, the intraocular pressure decreases to
7-8 mm RS itт симптом почти всегда возникает на фоне других
- Systemic inflammatory processes affecting the ciliary
- After antiglaucoma surgeries.
- With a sharp decrease in blood pressure.
- Haveремической или диабетической коме.
- After an eye injury.
Symptoms of ophthalmic hypotension – clouding and wrinkling
corneas, clouding of the vitreous body, reduced vision. Eye with
This is reduced in size.
Statistics and norms
The highest IOP is observed in newborns, then gradually
уменьшается до 10 years old. From the age of 20 a slow trend has been observed.
growth, and from 70 years – to decline.
Норма: 10 – 21 mm RS Age differences
average eye tone is very slight and usually not
exceed 1.5 mm RS Therefore, the norms of eye pressure in 40, 50 years
and after 60 years are not much different.
- The norm of eye pressure in women is slightly higher than in men, not
more than 1 mm.
- In summer, IOP is slightly less than in winter, in the morning more than
in the evening.
- Elevated IOP figures are found in 7.5% of people over 40,
- After 50 years, this figure reaches 20%.
Симптомы elevated ВГД
Increased eye pressure may not give for a long time.
symptoms. Can also be observed:
- pressing pain in eyes;
- decreased vision, which develops gradually;
- the appearance of interference, flies before his eyes;
- rainbow circles when looking at the light source;
- impaired adaptation of the eye to the dark.
Since all of these symptoms of ocular pressure are nonspecific and
develop gradually, a person can not give them a long time
values and do not consult a doctor. So, боли и распирание в глазах
can be taken for overwork from working with a computer, for
migraine, hypertension or vasospasm.
But even if there are no signs, long untreated
ophthalmic hypertension can trigger irreversible changes in
Glaucoma – это заболевание, при котором высокое ВГД приводит к
irreversible changes in the optic nerve, visual impairment and
blindness. In the initial stages, it is also not always accompanied.
symptoms. With the progression of the disease can
- pain in one or both eyes;
- reduced visual acuity, not amenable to correction points;
- violation of peripheral vision: a person sees objects in front of
by itself, and objects from the sides may not notice;
- the appearance of spots of “blurring” in the field of view;
- acute glaucoma attacks may occur – a sharp rise
eye strain, accompanied by pain, decreased vision,
eye strain, fixed pupil, sclera redness.
Glaucoma is open-angle and closed-angle. The names of these
forms correspond to the pathogenesis of the disease and the state of the anterior angle
cameras. With open-angle form, the drainage system in this corner
insignificantly violated, so this form can be for a long time.
asymptomatic. With angle-closure glaucoma, anterior angle
cameras less than 30 degrees, so its main reason is
violation of the outflow of intraocular fluid.
The most common form is the primary open angle.
The main diagnostic criteria for glaucoma:
- Loss of visual fields according to perimetry.
- Changes in the fundus of the type of expansion or deepening
excavation of the optic nerve head.
- Persistently high eye pressure and inherent symptoms –
important, but not the main criterion for glaucoma. As there are
rare forms of glaucoma where eye pressure is normal
Untreated glaucoma is the most common cause of complete
The main risk group for glaucoma is persons over 60 years of age with
hypertension, diabetes, as well as receiving
What is dangerously high intraocular pressure?
Constantly elevated IOP is fraught with compression of the visual disk
nerve that is located on the retina. As a result of the violation
nutritional nerve fibers atrophy. First loss occurs
peripheral vision, and then complete blindness can occur, and
Tactics in detecting increased IOP
A single identification of elevated IOP numbers does not give rise to
make a diagnosis. It is necessary to remember the physiological factors
affecting this indicator.
|Drinking 1 liter of water||At 4.4 mm RS||2.5 hours|
|1 cup of coffee||4 mm ps||1,5 hour|
|Alcohol||At 3.7 mm RS||1 hour|
|Physical exercise||At 4.3 mm RS||Около 1 hourа|
In addition, pseudohypertension is also distinguished – this is a short-term
IOP increase just before its measurement (nervous tension,
When a newly detected increase in IOP is assigned to control
measurements. Ideally, it is desirable to conduct daily tonometry. it
measuring eye pressure at the same time in the morning and in the evening
for at least three days. Adverse Criteria
- persistent high IOP;
- daily fluctuations in IOP more than 5 units;
- pressure difference on the right and left eye more than 4 units.
Daily tonometry is preferably carried out in the hospital. Clear,
that in practice it is almost impracticable. Therefore usually assigned
measuring outpatient several times every other day.
Special contact lenses with IOP sensors,
they transmit his performance during the day to electronic
The ophthalmologist will also advise you to be examined by
general practitioner, endocrinologist, cardiologist to exclude concomitant
The revealed high IOP does not mean the development of glaucoma at all. Have
2/3 cases of elevated ocular pressure in adults are not detected
no other symptoms or changes in the fundus. But doctors
include such patients as threatened by glaucoma and strongly
recommend observation and treatment.
If a persistent increase in IOP is detected, an examination is scheduled.
for the detection of glaucoma:
- Visiometry is a study of visual acuity.
- Perimetry – a study of peripheral vision.
- Gonioscopy. it осмотр угла передней камеры с помощью
special mirror lens.
- Ophthalmoscopy – fundus examination with
Benign ophthalmic hypertension does not need intensive
treatment, observation is recommended. Although many doctors adhere to
opinions that IOP is still better to reduce.
If high pressure has occurred for other reasons, then
elimination of these factors in itself leads to its decrease. So,
for example, the abolition of steroid hormones leads to full normalization
IOP for 2 weeks. Mandatory normalization required
blood pressure, blood sugar, thyroid hormones
The basic principles of eye pressure treatment are as follows:
- Drug reduction of IOP to target level
(usually up to 16-18 mm)
- Treatment сопутствующих заболеваний, устранение факторов
- In the absence of the effect of conservative treatment – surgery
to improve the outflow of aqueous humor.
The main method of reducing IOP is the use of antihypertensives.
drops. Принцип actions капель – это сужение зрачка, открытие угла
anterior chamber of the eye, as well as reduced secretion fluid. Main
groups of drugs:
- Adrenergic blockers (Timolol, Arutymol, Okumed, Timoptik)
- Cholinomimetics (Pilocarpine, Carboholol).
- Carboanhydrase inhibitors Dorzolamide (Truzopt, Dorzolamide,
Dorzopt), Brinzolamid (Azopt, Azarga, Brinzopt).
- Prostaglandins (Xalatan, Glaumaks, Prolatan, Trilakan,
Glauprost, Latanoprost, Travatan, Travapress).
- Combination drugs (Xalac, Fotil, Pilotimol, Kosopt,
Dorzopt, Xalakom, Duaprost).
Preparations are selected individually, at first one is prescribed,
with inefficiency – added drops from another group. 2-3 times
a year it is recommended to change the scheme as it develops
In glaucoma, if treatment with drops is ineffective, it is prescribed
operation – iridotomy, iridectomy, trabeculoplasty.
- Annual examination by an ophthalmologist with IOP measurement after 40
- Seeking a doctor for visual impairment.
- Mandatory pressure control in patients with chronic
diseases, as well as taking steroids.
- Adhere to the prescribed treatment regimen, do not cancel drops
on their own.
- Compliance with the regime of work and rest, visual mode.
- Treatment хронических diseases.