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Increased corneal thickness simulating elevated intraocular pressure.

M Johnson, M A Kass, R A Moses

    Archives of Ophthalmology (Chicago, Ill. : 1960)
    |April 1, 1978
    PubMed
    Summary
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    A young patient

    Area of Science:

    • Ophthalmology
    • Corneal Physiology
    • Intraocular Pressure Measurement

    Background:

    • Elevated intraocular pressure (IOP) is a risk factor for glaucoma.
    • Accurate IOP measurement is crucial for diagnosis and management.
    • Corneal properties can influence tonometry readings.

    Observation:

    • A 17-year-old female presented with high IOP readings (30-40 mm Hg) in both eyes.
    • Standard medical treatment failed to significantly reduce IOP.
    • Central corneal thickness measured 0.90 mm, which is significantly thicker than average.
    • Direct anterior chamber measurement revealed a true IOP of 11 mm Hg.

    Findings:

    • Multiple tonometry devices (Goldmann, Perkins, Schiötz, etc.) consistently overestimated IOP.

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  • The overestimation correlated with the patient's exceptionally thick corneas (0.90 mm).
  • Actual IOP measured via anterior chamber cannulation was within normal limits.

    • Implications:

    • Extremely thick corneas can lead to significant overestimation of intraocular pressure by standard tonometry.
    • Corneal thickness measurement is essential when IOP readings are discordant with other clinical signs.
    • This case highlights the importance of considering corneal biomechanics in IOP assessment to prevent misdiagnosis of ocular hypertension or glaucoma.