Measuring the twentyfourhour pressure curve Fig 106 This examination is performed to analyze fluctuations of the pressure level over a 24hour period in patients with suspected glaucoma

H A single measurement may not be representative. Only a 24-hour curve provides reliable information about the pressure level.

Intraocular pressure fluctuates in a rhythmic pattern. The highest values frequently occur at night or in the early morning hours. In normal patients, these fluctuations in intraocular pressure rarely exceed 4-6mm Hg.

Pressure is measured on the ward at 6:00 a.m., noon, 6:00 p.m., 9: 00 p.m., and midnight. Outpatient 24-hour pressure curves without nighttime and early morning measurements are less reliable.

H In glaucoma patients maintained on eyedrops, special attention should be given to the time of application. Pressure is measured immediately prior to applying the eyedrops. In this manner, measurements are obtained when the effect of the eyedrops is weakest.

Tonometric self-examination: Recent developments have made it possible for patients to measure intraocular pressure themselves at home in a manner similar to self-monitoring of blood pressure and blood glucose (Fig. 10.7). The patient tonometer makes it possible to obtain a 24-hour pressure curve from

— Twenty-four-hour pressure curve.

— Twenty-four-hour pressure curve.

Fig. 10.6 The colored dots represent the times of the measurements. The time of the initial application of anti-glaucoma eyedrops is marked (arrow). The time, frequency, and eye of eyedrop application are also identified.

244 10 Glaucoma — Tonometric self-examination.

244 10 Glaucoma — Tonometric self-examination.

Fig. 10.7 The patient places the tonometer on his or her forehead and uses the fixation light to align it in the proper position. The head of the tonometer then automatically presses against the cornea, measures intraocular pressure, and retracts. Pressure is indicated in a digital display.

any number of measurements obtained under normal everyday conditions. A patient tonometer may be prescribed in applicable cases (such as increased risk of acute glaucoma). However, using the device requires a certain degree of skill on the part of the patient. Patients who have problems applying eye-drops are best advised not to attempt to use a patient tonometer. Younger and well motivated patients are the best candidates for tonometric self-examination.

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