Pediatric glaucoma: IOP, axial length, and surgery indications

Abstract

If possible, it is best to measure intraocular pressure (IOP) in a cooperative, alert and wakeful child. Many different variables can affect IOP measurement in the pediatric age group. These include cooperation (if measuring IOP in the clinic), anesthetic agents and the mode of airway securement (if measuring IOP during examination under anesthesia (EUA)), the tonometer being used, central corneal thickness (CCT), and corneal hysteresis. The great variability and interplay between these factors make it difficult to know if one is truly obtaining an accurate measure of the IOP. This uncertainty is why clinical experience can be vital and why other findings - the optic nerve exam, corneal diameter, and axial length - should be weighed more heavily over IOP when making judgments as to whether a child's glaucoma is stable or progressing. The following paragraphs provide evidence-based facts as to how these variables may affect IOP, in order to help you interpret IOP readings in children. © 2010 Springer-Verlag Berlin Heidelberg.