How to Understand Eye Pressure (Glaucoma)?

How to understand eye blood pressure, the question is frequently wondered, especially by people of advanced age. Increased intraocular pressure, also known as ocular hypertension, is a condition in which the pressure inside the eye exceeds normal limits. Intraocular pressure is expressed in millimeters of mercury (mmHg). Normal eye pressure values are on average between 10-21 mmHg, and this pressure is measured with a device called a tonometer. It is recommended that patients with intraocular pressure higher than 21 mmHg undergo a detailed and comprehensive examination for ocular hypertension. High pressure inside the eye is usually caused by problems in the drainage of fluid in the eye. The clear fluid called aqueous humor, which is constantly present in the structure of the eye and continues to be produced, normally flows out or is drained at certain rates. Intraocular pressure above normal values may result from the aqueous humor not being drained at the required time and in the required amount.

How to Understand Eye Pressure (Glaucoma)?

Intraocular pressure being higher than normal is known as glaucoma. The presence of certain criteria is important for the diagnosis of ocular hypertension. These criteria can be roughly summarized as follows.

• Measurement of intraocular pressure, that is, eye pressure, higher than 21 mmHg as a result of more than one eye examination performed at different times
• Intraocular pressure (optic nerve) No damage
• No abnormality detected in the visual field test that evaluates peripheral vision and no signs of glaucoma
• No diagnosis of any ocular disease

In the presence of high eye pressure, the drainage system in the eye is evaluated to determine the exact cause. During the examination performed by a specialist ophthalmologist, the drainage mechanism of the fluid in the eye, also known as the angle, is examined. Whether the angle examined by gonioscopy is closed or open is a guide for various diseases.

Ocular hypertension is not expressed as a disease on its own. This term is often used for patients who have the onset of glaucoma and require close monitoring. In other words, ocular hypertension is used in the presence of glaucoma suspicion or to identify patients who are candidates for glaucoma. The most important distinction between glaucoma and ocular hypertension is that the optic nerve is affected, and this can be easily evaluated by eye examination. There may be many reasons for the increase in intraocular pressure. In ocular hypertension, there is no optic nerve damage or vision loss, only an increase in intraocular pressure. In glaucoma, there is typically optic nerve damage and vision loss is described by the person. High intraocular pressure is not among the absolute criteria for glaucoma. In some cases, normal intraocular pressure glaucoma may also occur. Since glaucoma is a disease that can result in high vision loss and permanent blindness in the future, early detection and intervention is very important, especially for people with ocular hypertension. Although the cause of glaucoma is not exactly known, many glaucoma patients experience high eye pressure. Therefore, treatment approaches that reduce intraocular pressure can prevent the progression of glaucoma. Individuals at high risk of developing glaucoma are as follows.

• Having a family history of glaucoma
• Being over 60 years of age
• Being over 40 years of age and having black skin
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What are the Risk Factors for Eye Pressure (Glaucoma)?

Risk factors refer to situations where the chance of contracting a disease is high. Some risk factors cannot be changed. These are factors such as age, gender, ethnicity, family history. Modifiable risk factors are very important in the course of the disease and the success of treatment. Risk factors for ocular hypertension and glaucoma can be summarized as follows.

• Presence of hypertension and hypotension
• Diabetes
• Myopia (not being able to see clearly in the distance)
• Thinning of the cornea, a transparent structure responsible for protecting the eye
• Damage and bleeding in the optic nerve
• Pigment dispersion syndrome (SPD), which is characterized by the shedding of pigment tissue in the colored part of the eye (iris) and causing obstruction in the drainage system
• Known as pseudoexfoliation syndrome (PEX-S), it occurs in various parts of the body, including the eyes. accumulation of protein particles
• Being over 40 years of age
• Family history of glaucoma or ocular hypertension
• Having black skin or Hispanic origin
• Tall long-term use of steroid drugs
• Previous eye trauma or eye surgery history

Causes of Eye Pressure (Glaucoma)

Ocular hypertension may have various causes. These reasons include excessive aqueous humor production or inadequate drainage due to a disorder in the drainage system. Obstruction in the eye's drainage mechanism, called the anterior chamber angle, also often leads to high eye pressure. If the drainage angle is blocked for any reason, an increase in intraocular pressure occurs with increased fluid. Obstruction of the angle can be seen mainly for the following reasons.

• Narrowness or closure in the drainage angle
• Failure to drain properly even though the anterior chamber is open
• Pigment or protein particles due to blockage
• Eye tumors
• Eye trauma
• Intense stress

What Level of Eye Pressure (Glaucoma) Causes Symptoms?

The biggest obstacle to early recognition of ocular hypertension and successful treatment is that it usually does not cause symptoms. Therefore, routine eye examination and eye pressure measurements are important. Although in some cases pain and tenderness during eye movement, headache, dizziness and decreased visual field may occur, these situations are quite rare.

How to Detect Eye Pressure?

After a detailed history and comprehensive physical examination taken by a specialist and experienced ophthalmologist, further tests may be important for the diagnosis of eye pressure when necessary. Tests to be requested in cases of suspicion of ocular hypertension can be listed as follows.

• Gonioscopy: It is used to evaluate the drainage system of the eye, also known as the anterior chamber angle. Examination is achieved with a specially produced lens and a type of microscope called a slit lamp.
• Pachymetry: It is used to measure the thickness of the transparent layer at the front of the eye, that is, the cornea. During this procedure, no contact is made with the eye and the process is completed very quickly with computerized systems.
• Tonometry: It is a device used to measure intraocular pressure. It is based on the principle of spraying pressurized air into the eye and measuring the pressure inside the eye with computerized systems. It is a short, easy and generally painless procedure.
• Visual Field Test: With the visual field examination, the peripheral vision of individuals is evaluated.
• Optical Coherence Tomography (OCT): Light-sensitive tissue located at the back of the eye. It is a preferred imaging method for evaluating the retina, which is the layer of the retina. It does not contain radiation and has a wide application area today. It is possible to evaluate the optic nerve tissue with this test.

How to Treat Eye Pressure?

The main goal of treatment for high eye pressure is to lower the blood pressure. Regular follow-up and compliance with treatment are important for patients to obtain effective results and prevent permanent damage. There are various procedures used to lower intraocular pressure. These procedures can be summarized as follows.

• A number of drug therapies such as prostaglandins, carbonic anhydrase inhibitors, miotic and cholinergic drugs, alpha adrenergic agonists, beta blockers: Various drugs are used to reduce the amount of fluid produced in the eye and increase the drainage of the fluid. Medicines can be prescribed.
• Surgical operations: If there is no response to the prescribed medicines or if the side effect profile is very high, surgery is one of the treatment options to reduce eye pressure. Laser trabeculoplasty, which can be applied to open the obstruction in the presence of obstruction, is among the surgical options.

Ocular hypertension is a condition in which the pressure inside the eye is higher than normal and there is no damage to the optic nerve. One of the most common symptoms is a narrowed visual field. Although it can occur due to different diseases, it can also be caused by a defect in the discharge mechanism of the fluids naturally secreted by the eye. Our optic nerve may be damaged due to ocular hypertension. Therefore, the risk of developing glaucoma is much higher in the presence of ocular hypertension. High eye pressure is not always symptomatic and diagnosis may therefore be delayed in many patients. Not skipping routine eye examinations and complying with the specialist ophthalmologist's instructions and treatment plan are important for early diagnosis and treatment. Intervening in high eye pressure without causing permanent nerve damage and vision loss produces satisfactory results. The risk of eye pressure can be reduced and treatment success increased with approaches such as regular eye examinations, quitting smoking, staying away from stressful life, and proper and balanced nutrition. Ocular hypertension is not a preventable disease, but glaucoma is a preventable disease.