[What to do if the intraocular pressure measurement does not appear reliable]

Among the various intraocular pressure (IOP) measurement methods available today, Goldmann applanation tonometry (GAT) remains the gold standard for in-office routine IOP measurement. However, numerous factors may affect IOP measurement with GAT, namely corneal features. Before any interpretation of an IOP value, the measurement conditions should be checked and the central corneal thickness evaluated, since GAT overestimates IOP in thick corneas and underestimates IOP in thin ones. When GAT is not applicable, other IOP measurement devices, which have their own limits, are available. For example, the ocular response analyzer (ORA) and dynamic contour tonometry (DCT) provide IOP readings that are less influenced by corneal properties and may be useful after refractive surgery. Regardless of the choice of tonometer, the IOP value must not be considered alone but from a clinical point of view, including, namely, multiple IOP measurements over a day since the IOP fluctuates over a 24-h time period. A complete clinical examination is necessary in each case to search for glaucomatous neuropathy.