Intraocular Pressure Stratification & Glaucoma Risk
Categorises Goldmann applanation IOP against the NICE NG81 referral and treatment threshold (24 mmHg) and the College of Optometrists' urgency thresholds (over 35 mmHg urgent, 40 mmHg or more emergency). Thin corneas tend to under-read; central corneal thickness is weighed as a separate risk factor (NICE NG81).
Score interpretation
21 mmHg or less — within the statistical normal range.
→ If glaucoma suspect (disc cupping, family history): repeat IOP, OCT-RNFL, visual fields, gonioscopy. Otherwise routine optometry interval.
Above the statistical normal range but below 24 mmHg.
→ NICE NG81: with IOP below 24 mmHg and a normal disc and field, continue regular visits to the primary eye care professional; repeat the measurement and consider other risk factors (CCT, family history, age).
24 mmHg or more on Goldmann-type applanation (NICE NG81).
→ Repeat on another occasion, then refer for diagnosis (NICE NG81). If ocular hypertension is confirmed and the person is at risk of visual impairment in their lifetime: offer 360° SLT, or a generic prostaglandin analogue if SLT is declined or unsuitable. Assess risk from IOP, CCT, family history and life expectancy.
Over 35 mmHg: urgent referral to the hospital eye service (College of Optometrists).
→ Urgent hospital eye service referral; look for angle closure, uveitic or neovascular glaucoma, or a traumatic hyphaema with secondary rise.
40 mmHg or more: emergency referral (College of Optometrists).
→ 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.
- Selexipag · Pulmonary Arterial Hypertension
- Macitentan · Pulmonary Arterial Hypertension
- Retinol palmitate with white soft paraffin, light liquid paraffin, liquid paraffin and wool fat · Ocular lubricant ointment
- Yellow soft paraffin · Emollient / Ocular lubricant
- Propranolol (Portal Hypertension) · Antihypertensive
- Carvedilol (Portal Hypertension) · Non-Selective Beta-Blocker with Alpha₁-Blocking Activity
- Acute Red Eye / Vision Loss Screen · RCOphth 2020; NICE CKS
- Idiopathic Intracranial Hypertension · ABN; consensus 2018
- Acute Red Eye Assessment · RCOphth / AAO
- Acute Angle Closure Glaucoma · RCOphth / EGS Guidelines
- Retinal Detachment · RCOphth Guidelines / EURETINA
- Diabetic Retinopathy — Screening and Management · NICE NG28 2016 / NHS DES Programme
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.