The third in our series of 4 video blogs which focuses on common and sometimes severe eye conditions encountered in practice. The aim of these case studies is to highlight ocular issues that need investigating or are discovered at routine examinations.

Mr L - Ocular Hypertension Case Study

Ocular hypertension is when the pressure inside the eye (intraocular pressure or IOP) is higher than usual.

With ocular hypertension, the front of the eye does not drain fluid properly, causing pressure to build up. Higher than normal eye pressure can cause glaucoma, a disease in which eye pressure damages the optic nerve, causing vision loss.

Ocular hypertension is not the same as glaucoma. With ocular hypertension, the optic nerve looks normal, and there are no signs of vision loss. However, people with ocular hypertension are at increased risk for glaucoma and are considered “glaucoma suspects.” 

Ocular hypertension usually does not have any signs or symptoms. Because you can have high eye pressure and not know it, it is essential to have regular eye exams with your ophthalmologist to check for glaucoma.

What Causes Ocular Hypertension?

A clear fluid called aqueous humour flows inside the front of your eye. Your eye continually makes aqueous humour while an equal amount of it flows out of your eye. This keeps a constant healthy eye pressure.

If the aqueous humour does not flow out of the eye properly, pressure builds up and causes ocular hypertension. If high pressure causes damage to the optic nerve, it leads to glaucoma. Glaucoma causes vision loss.

Who Is at Risk for Ocular Hypertension?

Anyone can develop ocular hypertension, but some people have a higher risk for this condition. They include:

• those with a family history of ocular hypertension or glaucoma

• people who have diabetes or high blood pressure

• people over the age of 40

• African-Americans and Hispanics

• people who are very myopic (nearsighted)

• people who take long-term steroid medications

• people who have had eye injuries or surgery

• those with pigment dispersion syndrome or pseudoexfoliation syndrome (PXF)

How Is Ocular Hypertension Diagnosed?

Your ophthalmologist will measure the pressure in your eye. During this test, your eye is numbed with eye drops. Your doctor uses a tonometer to measure how your cornea resists slight pressure. This helps determine your eye pressure.

Your ophthalmologist will also check for glaucoma. They will examine your optic nerve for signs of damage and check your side (peripheral) vision.

How Is Ocular Hypertension Treated?

Lowering high eye pressure before it causes vision loss or damage to the optic nerve is essential.

If your eye pressure is only slightly elevated, your ophthalmologist may decide not to start treatment immediately. Instead, he or she will monitor pressure with regular testing.

However, your ophthalmologist may decide you need eye-drop medicine to lower your intraocular pressure. They will schedule a visit within several weeks of starting the medicine to see how it works.

Sometimes, your ophthalmologist may prescribe more than one medicine. For the drops to work, it is important that you follow the directions exactly. Sometimes, laser or surgery is used to lower eye pressure.

Treatment decreases your risk of glaucoma, but it does not eliminate the risk. Some patients with ocular hypertension may go on to develop glaucoma. If that happens, your ophthalmologist will talk with you about treatment options.

If you have any questions, be sure to ask them. Your ophthalmologist is committed to protecting your sight.

Thank you Mr. L for sharing your story.

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