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increased intraocular pressure (IOP)

Etiology: 1) either over-production or impaired drainage of aqueous humor 2) pharmacologic causes: a) mydriatics b) sympathomimetics Pathology: -> significant &/or prolonged increases in IOP may lead to open-angle glaucoma Management: 1) treatment is cost effective if life-expectency is >= 18 years [5] 2) prognosis a) 85% of patients with elevated IOP (> 22 mm Hg) do NOT have glaucoma & will NOT develop glaucoma within the next 5 years b) at 5 years, reducing IOP by 20% in patients with IOP of 24-32 mm Hg, reduces risk of visual field abnormality or optic disc deterioration from 9.5 to 4.4% [3] c) number needed to treat: 12 patients to prevent one case of visual field defects of optic nerve changes consistent with glaucoma [4] 3) see open angle glaucoma

Related

glaucoma intraocular pressure (IOP) ocular hypotony

General

eye disease (ophthalmopathy) sign/symptom

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 66
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
  3. Journal Watch 22(15):115, 2002 - Kass MA et al The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delay or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 120:701, 2002 PMID: 12049574 - Gordon MO et al The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophthalmol 120:714, 2002 PMID: 12049574 - Palmberg P Answers from the ocular hypertension treatment study. Arch Ophthalmol 120:829, 2002 PMID: 12049591
  4. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  5. Kymes SM, Plotzke MR, Kass MA, Boland MV, Gordon MO. Effect of patient's life expectancy on the cost-effectiveness of treatment for ocular hypertension. Arch Ophthalmol. 2010 May;128(5):613-8. PMID: 20457984
  6. Boey PY, Mansberger SL. Ocular hypertension: an approach to assessment and management. Can J Ophthalmol. 2014 Dec;49(6):489-96. Review. PMID: 25433737