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ophthalmology

Intraocular Pressure Stratification & Glaucoma Risk

Categorises Goldmann applanation IOP (best of multiple readings, mid-morning) for ocular-hypertension and glaucoma decisions. Apply central corneal thickness (CCT) correction (Ehlers / Dresdner) where available — thin cornea (<540 µm) underestimates true IOP by ~2–5 mmHg.

Used in: Acute Red Eye

Score interpretation

Normal IOP 0

→ If glaucoma suspect (disc cupping, family history): repeat IOP, OCT-RNFL, visual fields, gonioscopy. Otherwise routine optometry interval.

Borderline ocular hypertension (22–24) 1

→ Confirm with repeat readings + CCT. Per NICE NG81: no treatment if no other risk factors and CCT >555 µm; consider treatment in higher-risk patients (thin cornea, family history, Afro-Caribbean ethnicity).

Ocular hypertension (25–29) 2

→ Per NICE NG81 — offer 360° SLT first-line, alternative is topical PGA (latanoprost) target ≥20% reduction. Annual OCT + visual fields; treat to target IOP.

Markedly–severely elevated IOP 3–4

→ Same-day ophthalmology assessment (rule out acute angle closure, uveitic glaucoma, traumatic hyphaema with secondary rise, neovascular glaucoma). Initial topical β-blocker + α-agonist + topical/oral CAI ± osmotic agent (mannitol/glycerol) if angle closure. Definitive surgical / SLT plan once acute episode controlled.

Interpretation bands for the IOP Risk. Apply clinical judgement and local guidance.

References

Related

Curated clinical cross-links plus same-class fallbacks.

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.