Methods of measuring intra ocular pressure

What is intra ocular pressure ? Definition Intra ocular pressure refers to the pressure exerted by the intra ocular contents on the coats of the eyeball. Intra ocular pressure refers to the pressure exerted by the intra ocular contents on the coats of the eyeball. It is maintained by the equilibrium between the aqueous humour formation, its outflow and the episcleral venous pressure It is maintained by the equilibrium between the aqueous humour formation, its outflow and the episcleral venous pressure Normal IOP – 10.2mmhg to 20.6mmhg

Types of Tonometer Schiotz Tonometer Schiotz Tonometer Applanation Tonometer- Goldman Applanation Tonometer- Goldman Tonopen Tonopen Pulse air Tonometer Pulse air Tonometer Non contact Tonometer Non contact Tonometer

Schiotz Tonometer Devised in the year 1905 Schiotz tonometer is the instrument which is used to measure the intra ocular pressure ( IOP ) Schiotz tonometer is the instrument which is used to measure the intra ocular pressure ( IOP )

Requirements (Schiotz tonometer) Schiotz tonometer with 5.5gm,7.5gm and 10gm weight Schiotz tonometer with 5.5gm,7.5gm and 10gm weight Measurement chart (Friedan Wald chart) Measurement chart (Friedan Wald chart) 4% Xylocaine as local anaesthetic 4% Xylocaine as local anaesthetic Wiper jar (Sterile) Wiper jar (Sterile) Kidney type tray Kidney type tray Antibiotic drops (Chloramphenical ) Antibiotic drops (Chloramphenical ) 2% propanolol &Tissue paper 2% propanolol &Tissue paper

Method Explain the procedure to the patient and make him comfortable. He should be lying down with head on the pillow. Explain the procedure to the patient and make him comfortable. He should be lying down with head on the pillow. Check the instrument by placing over the model. Now the indicator ‘0’in the scale Check the instrument by placing over the model. Now the indicator ‘0’in the scale Wash and dry hands. Wash and dry hands. Instill one drops of lignocaine 4%eyedrops in the Eye (use pouch technique) – Explain the burning sensation & other points Instill one drops of lignocaine 4%eyedrops in the Eye (use pouch technique) – Explain the burning sensation & other points Allow 2to5minutes for the local drops to act. Allow 2to5minutes for the local drops to act.

Ask the patient to look straight up Ask the patient to look straight up Separate the eyelids, putting no pressure on the eye. Fingers should rest on the orbital margin. Separate the eyelids, putting no pressure on the eye. Fingers should rest on the orbital margin. Hold the tonometer so that footplate rests on the center of the cornea. Hold the tonometer so that footplate rests on the center of the cornea. Look at the scale of the Tonometer to find out the degree of indentation. If the weight is not enough to indent the cornea, use a heavier weight Look at the scale of the Tonometer to find out the degree of indentation. If the weight is not enough to indent the cornea, use a heavier weight Use the chart to calculate the intraocular pressure for that particular weight, and that degree of indentation Use the chart to calculate the intraocular pressure for that particular weight, and that degree of indentation Record the intraocular pressure in the patients note’s Record the intraocular pressure in the patients note’s

Sterilizing the instruments Before replacing the tonometer, dismantle it and clean the parts. Before replacing the tonometer, dismantle it and clean the parts. Remove the weights, unscrew the plunger and clean them using swabs dipped in alcohol Remove the weights, unscrew the plunger and clean them using swabs dipped in alcohol Heat the footplate over the blue flame of the spirit lamp for two minutes. Now the footplate is sterilized Heat the footplate over the blue flame of the spirit lamp for two minutes. Now the footplate is sterilized Keep the tonometer over the sterile wipers/pad so that it cools down to room temperature Keep the tonometer over the sterile wipers/pad so that it cools down to room temperature Check the instruments by placing over the model. Now the indicator should show ‘0’in the scale Check the instruments by placing over the model. Now the indicator should show ‘0’in the scale

Tonopen Tonopen could be used for children and adults Tonopen could be used for children and adults Before measuring, local anesthetic drops are to be applied Before measuring, local anesthetic drops are to be applied The patient can either sit or lie down The patient can either sit or lie down

The tip of tonopen touches the central part of cornea. We should handle it smoothly The tip of tonopen touches the central part of cornea. We should handle it smoothly This could be used for patients who can not be checked with Applanation Tonometer &corneal disorder patients & children This could be used for patients who can not be checked with Applanation Tonometer &corneal disorder patients & children

Pulse Air Tonometer Pulse Air Tonometer could be used for all age group. Pulse Air Tonometer could be used for all age group. Mostly used for children Mostly used for children It could be used effectively on children when they sleep It could be used effectively on children when they sleep Only through air pressure we will be able to measure Only through air pressure we will be able to measure

This is an automatic Tonometer This is an automatic Tonometer Need not use anesthetic drops Need not use anesthetic drops Normal value 12 to 21mmhg Normal value 12 to 21mmhg Pulse Air Tonometer = Non contact Tonometer Pulse Air Tonometer = Non contact Tonometer Distance of Tonometer & Cornea is 10 to 12mm Distance of Tonometer & Cornea is 10 to 12mm

Non contact Tonometer

This is like the slit lamp This is like the slit lamp Patients is to be focused to see the red-light inside the Tonometer Patients is to be focused to see the red-light inside the Tonometer Picture of the eye could be seen on the screen Picture of the eye could be seen on the screen A white dot will be seen in the cornea A white dot will be seen in the cornea The MLOP should focus the white dot and click it The MLOP should focus the white dot and click it At the time of focusing, if you see the word- ’Forward’,you should adjust the joystick in front side. At the time of focusing, if you see the word- ’Forward’,you should adjust the joystick in front side.

At the time of focusing, if you see the word-’Too close’,you should adjust the joystick in back side. At the time of focusing, if you see the word-’Too close’,you should adjust the joystick in back side. Automatically the reading will be shown in the screen itself Automatically the reading will be shown in the screen itself This will be useful for injury and redness and post operative patients This will be useful for injury and redness and post operative patients No need to use local drops. No need to use local drops.

Applanation Tonometer (Goldman’s)

Goldman’s applanation Tonometer is capable of measuring intraocular pressure accurately to 0.5mm Goldman’s applanation Tonometer is capable of measuring intraocular pressure accurately to 0.5mm It is more accurate than Schiotz Tonometer It is more accurate than Schiotz Tonometer This is used with slit lamp microscope This is used with slit lamp microscope It measures the area of the circle made flat by the instrument on the flat and spherical part of the cornea It measures the area of the circle made flat by the instrument on the flat and spherical part of the cornea It has prism with external area of the Tonometer It has prism with external area of the Tonometer A measuring drum attached to the slit lamp is inserted into the handle over the chamber A measuring drum attached to the slit lamp is inserted into the handle over the chamber

Procedure Explain the method to the patient and keep the patient in front of the slit lamp Explain the method to the patient and keep the patient in front of the slit lamp Apply local anesthetic to the eye and add a drop of flourescein with the help of a flourescein strip Apply local anesthetic to the eye and add a drop of flourescein with the help of a flourescein strip Make the patients rest his chin in its place Make the patients rest his chin in its place Use blue filter to focus the conjunctiva, open the slit beam, which is angled at 45-60° to the chamber Use blue filter to focus the conjunctiva, open the slit beam, which is angled at 45-60° to the chamber

Make the patient open her eyes and keep that straight.There should be no friction between the margin of the lid and the instrument lest it causes the patient to blink Make the patient open her eyes and keep that straight.There should be no friction between the margin of the lid and the instrument lest it causes the patient to blink When the patient is ready, arrange the measuring drum. Move it along with slit lamp control lever so that the Tonometer is near the centre of the cornea When the patient is ready, arrange the measuring drum. Move it along with slit lamp control lever so that the Tonometer is near the centre of the cornea Two bright yellow and green semicircles will be visible through the eyepiece of the microscope. Focus them with the help of the control lever so that the vertical lines separating the two parts is equidistant from top and bottom Two bright yellow and green semicircles will be visible through the eyepiece of the microscope. Focus them with the help of the control lever so that the vertical lines separating the two parts is equidistant from top and bottom

Adjust the measuring drum towards upper valves. THE TWO SEMICIRCLES SUPERIMPOSE. The reading at which the two semicircles superimpose is noted. Adjust the measuring drum towards upper valves. THE TWO SEMICIRCLES SUPERIMPOSE. The reading at which the two semicircles superimpose is noted. Multiply the reading by 10. The intraocular pressure is read in mm of Hg Multiply the reading by 10. The intraocular pressure is read in mm of HgNote As the tonometer touches the cornea, it may cause infection. So clean the applanating tip and sterilize it with an antiseptic As the tonometer touches the cornea, it may cause infection. So clean the applanating tip and sterilize it with an antiseptic