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Elevated pressure a concern?

Article ID: 31
Last updated: 29 Aug, 2017
Revision: 1
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Question

My 8 year old daughter just left the eye doctor and he said her pressures were slightly elevated to 22 & 24 and last year was also slightly elevated to 20 & 21. Do I need to be concerned?

Answer

The answer to your question is not a straightforward one, because whether or not you should be concerned depends upon several important factors, which you would need to ask of your eye doctor.  They are as follows (note that the word "you" refers to the eye doctor in the following list): 

  1. are the eyes otherwise completely normal, and do you believe that the readings of 22 & 24 mmHg are accurate (the pressure may be falsely elevated due to anxiety on the part of the child, eyelid squeezing, breath holding, etc.)?
     
  2. if you believe the pressures are accurate, then are there any other features of the eye examination that would lead to a concern for possible glaucoma, such as thin corneas (measured by a simple ultrasound test in the office), optic nerve abnormalities (such as unusually large "cups" or a thin "rim" or "asymmetry" in the appearance of the nerves)?
     
  3. is there any family history of elevated eye pressures, and was this associated with glaucoma, or were the individuals simply monitored without any damage noted over time?
     
  4. has there been any unusual shift in the eyesight (particularly myopia or "near-sightedness" to suggest possible effect of elevated eye pressure in stretching the length of the eyes (note that sometimes myopia just develops as a genetic feature in families with many affected members but no glaucoma)?

So, to sum up, there are questions that you might want to ask your eye doctor, to determine whether you and he/she should worry about these slightly elevated eye pressures.  Most important of all is to monitor them over time, perhaps more often than annually, if there are any features to suggest that there may be possible concern that your daughter is a "glaucoma suspect".  Additionally, taking a photograph of the optic nerves is not a bad idea, just as a baseline, and you might wish to ask this of your eye care provider, to see what he/she thinks about that.

Sharon F. Freedman MD

Professor of Ophthalmology and Pediatrics Chief
Pediatric Division Duke Eye Center
2351 Erwin Road
Durham, NC 27710

Scientific Advisory Board
Pediatric Glaucoma and Cataract Family Association

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