CET feedback: Influences upon intraocular pressure

There was an excellent response to this exercise and some useful debate and discussion. The underlying aim was to emphasise that making any management decision about intraocular pressure (IOP) based upon one tonometry sitting is not particularly useful (unless reliably indicating a high enough pressure to risk damage such as venous occlusion) because of the variable nature of the value over the daily cycle. The case under discussion was deliberately devoid of any major glaucoma risk factors and the aim here was simply to note that the measured IOP values were at the upper end of the expected non-referable range but had been measured at a time of day where many patients (though by no means all) were likely to have a pressure at the lower end of their daily range. It might, therefore, be reasonable, to suggest that a repeat measurement in the morning might achieve a higher value and the average between the two fall into the category worthy of further investigation.