Ocular hypertension

ICD-10 | H40.0
ICD-9 | 365.04
DiseasesDB | 5226
MeSH | D009798

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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Ocular hypertension (OHT) is intraocular pressure higher than normal in the absence of optic nerve damage or visual field loss.[1][2]

Current consensus in ophthalmology defines normal introcular pressure (IOP) as that between 10 mmHg and 21 mmHg. Elevated IOP is the most important risk factor for glaucoma, so those with ocular hypertension are frequently considered to have a greater chance of developing the condition.

Intraocular pressure can increase when a patient lies down. There is evidence that some glaucoma patients (e.g., normal tension glaucoma patients) with normal IOP while sitting or standing may have intraocular pressure that is elevated enough to cause problems when they are lying down.

## Treatment

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### Medication

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Ocular hypertension are mostly treated with pilocarpine, timolol, acetazolamide and clonidine[3]. There are also other, less commonly used, alternatives. Eye drops may initially be started either in one or in both eyes.[4]

Comparison table of ocular antihypertensives  Medication  | Mechanism  | Dosage form[5] | Adverse effects[5]

|
|
|

pilocarpine | muscarinic agonist | eye drops
timolol | β-receptor antagonist |

* bradycardia
* bronchoconstriction

acetazolamide | carbonic anhydrase inhibitor | systemic administration |

* diuresis
* loss of appetite
* tingling
* neutropenia

clonidine | α2-receptor agonist | eye drops  |
ecothiopate | cholinesterase inhibitor | eye drops  |

* muscle spasm
* systemic effect

carteolol | β-receptor antagonist | eye drops  |

* bradycardia
* bronchoconstriction

dorzolamide | carbonic anhydrase inhibitor | eye drops  |

* bitter taste
* burning sensation

apraclonidine | α-2 agonist | eye drops  |
latanoprost | prostaglandin analogue  |  |

* ocular pigmentation

## Causes

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### Common Causes

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* Acute angle-closure glaucoma
* Axenfeld-rieger syndrome
* Chandler iris naevus syndrome
* Congenital glaucoma
* Corneal arcus
* Essential iris atrophy
* Excessive aqueous production
* Glaucoma
* Hyphema
* Inadequate aqueous drainage
* Pigment dispersion syndrome
* Posner-schlossman syndrome
* Pseudoexfoliation syndrome
* Refractive ocular surgery

### Causes by Organ System

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Cardiovascular | Amyloidosis

|

Chemical/Poisoning | No underlying causes
Dental | No underlying causes
Dermatologic | No underlying causes
Drug Side Effect | Antipsychotic agents, Atropine, Chlorpromazine, Cocaine, Glucocorticoids, Levomepromazine, Perazine, Phenelzine, Pipothiazine, Pizotifen, Prednisolone, Ranibizumab, Steroids, Topiramate, Tropicamide
Ear Nose Throat | No underlying causes
Endocrine | No underlying causes
Environmental | No underlying causes
Gastroenterologic | No underlying causes
Genetic | Alpha-l-iduronidase deficiency , Axenfeld-rieger syndrome, Chandler iris naevus syndrome, Congenital glaucoma, Hereditary onycho-osteodysplasia, Iridogoniodysgenesis type 1, Lowe syndrome, Moore-federman syndrome, Sturge-weber syndrome
Hematologic | Alpha-l-iduronidase deficiency , Cystathionine beta-synthase deficiency
Iatrogenic | Refractive ocular surgery
Infectious Disease | No underlying causes
Musculoskeletal/Orthopedic | Weill-marchesani syndrome
Neurologic | Fahr disease, Glaucoma
Nutritional/Metabolic | No underlying causes
Obstetric/Gynecologic | No underlying causes
Oncologic | No underlying causes
Ophthalmologic | Acute angle-closure glaucoma, Axenfeld-rieger syndrome, Chandler iris naevus syndrome, Congenital glaucoma, Corneal arcus, Essential iris atrophy, Excessive aqueous production, Glaucoma, Hyphema, Inadequate aqueous drainage, Pigment dispersion syndrome, Posner-schlossman syndrome, Pseudoexfoliation syndrome, Refractive ocular surgery
Overdose/Toxicity | No underlying causes
Psychiatric | Antipsychotic agents
Pulmonary | No underlying causes
Renal/Electrolyte | No underlying causes
Rheumatology/Immunology/Allergy | Amyloidosis
Sexual | No underlying causes
Trauma | Ocular trauma
Urologic | No underlying causes
Miscellaneous | No underlying causes

### Causes in Alphabetical Order

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* Acute angle-closure glaucoma
* Alpha-l-iduronidase deficiency
* Amyloidosis
* Antipsychotic agents
* Atropine
* Axenfeld-rieger syndrome
* Chandler iris naevus syndrome
* Chlorpromazine
* Cocaine
* Congenital glaucoma
* Corneal arcus
* Cystathionine beta-synthase deficiency
* Essential iris atrophy
* Excessive aqueous production
* Fahr disease
* Glaucoma
* Glucocorticoids
* Hereditary onycho-osteodysplasia
* Hyphema
* Inadequate aqueous drainage
* Iridogoniodysgenesis type 1
* Levomepromazine
* Lowe syndrome
* Moore-federman syndrome
* Ocular trauma
* Perazine
* Phenelzine
* Pigment dispersion syndrome
* Pipothiazine
* Pizotifen
* Posner-schlossman syndrome
* Prednisolone
* Pseudoexfoliation syndrome
* Ranibizumab
* Refractive ocular surgery
* Steroids
* Sturge-weber syndrome
* Topiramate
* Tropicamide
* Weill-marchesani syndrome

## References

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1. ↑ American Academy of Ophthalmology
2. ↑ American Optometric Association
3. ↑ Rang, H. P. (2003). Pharmacology. Edinburgh: Churchill Livingstone. ISBN 0-443-07145-4. Page 146
4. ↑ [ http://www.biomedcentral.com/1471-2415/7/17 Interpretation of uniocular and binocular trials of glaucoma medications]
5. ↑ 5.0 5.1 Unless else specified in boxes, then ref is: Rang, H. P. (2003). Pharmacology. Edinburgh: Churchill Livingstone. ISBN 0-443-07145-4. Page 146

## External links

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* National Eye Institute
* International Glaucoma Association

* v
* t
* e

* Diseases of the human eye (H00–H59
* 360–379)

Adnexa

| Eyelid|

| Inflammation|

* Stye
* Chalazion
* Blepharitis

|

* Entropion
* Ectropion
* Lagophthalmos
* Blepharochalasis
* Ptosis
* Blepharophimosis
* Xanthelasma

Eyelash|

* Trichiasis
* Madarosis

Lacrimal apparatus|

* Dacryoadenitis
* Epiphora
* Dacryocystitis
* Xerophthalmia

Orbit|

* Exophthalmos
* Enophthalmos
* Orbital cellulitis
* Orbital lymphoma
* Periorbital cellulitis

Conjunctiva|

* Conjunctivitis
* allergic
* Pterygium
* Pinguecula
* Subconjunctival hemorrhage

Globe

| Fibrous tunic|

| Sclera|

* Scleritis
* Episcleritis

|

Cornea|

* Keratitis
* herpetic
* acanthamoebic
* fungal
* Corneal ulcer
* Photokeratitis
* Thygeson's superficial punctate keratopathy
* Corneal dystrophy
* Fuchs'
* Meesmann
* Corneal ectasia
* Keratoconus
* Pellucid marginal degeneration
* Keratoglobus
* Terrien's marginal degeneration
* Post-LASIK ectasia
* Keratoconjunctivitis
* sicca
* Corneal neovascularization
* Kayser–Fleischer ring
* Haab's striae
* Arcus senilis
* Band keratopathy

Vascular tunic|

* Iris
* Ciliary body

* Uveitis
* Intermediate uveitis
* Hyphema
* Rubeosis iridis
* Persistent pupillary membrane
* Iridodialysis
* Synechia

|

Choroid|

* Choroideremia
* Choroiditis
* Chorioretinitis

Lens|

* Cataract
* Congenital cataract
* Childhood cataract
* Aphakia
* Ectopia lentis

Retina|

* Retinitis
* Chorioretinitis
* Cytomegalovirus retinitis
* Retinal detachment
* Retinoschisis
* Ocular ischemic syndrome / Central retinal vein occlusion
* Central retinal artery occlusion
* Branch retinal artery occlusion
* Retinopathy
* diabetic
* hypertensive
* Purtscher's
* of prematurity
* Bietti's crystalline dystrophy
* Coats' disease
* Macular degeneration
* Retinitis pigmentosa
* Retinal haemorrhage
* Central serous retinopathy
* Macular edema
* Epiretinal membrane (Macular pucker)
* Vitelliform macular dystrophy
* Leber's congenital amaurosis
* Birdshot chorioretinopathy

Other|

* Glaucoma / Ocular hypertension / Primary juvenile glaucoma
* Floater
* Leber's hereditary optic neuropathy
* Red eye
* Globe rupture
* Keratomycosis
* Phthisis bulbi
* Persistent fetal vasculature / Persistent hyperplastic primary vitreous
* Persistent tunica vasculosa lentis
* Familial exudative vitreoretinopathy

Pathways

| Optic nerve
Optic disc|

* Optic neuritis
* optic papillitis
* Papilledema
* Foster Kennedy syndrome
* Optic atrophy
* Optic disc drusen

Optic neuropathy|

* Ischemic
* anterior (AION)
* posterior (PION)
* Kjer's
* Leber's hereditary
* Toxic and nutritional

Strabismus
Extraocular muscles
Binocular vision
Accommodation|

| Paralytic strabismus|

* Ophthalmoparesis
* Chronic progressive external ophthalmoplegia
* Kearns–Sayre syndrome

palsies|

* Oculomotor (III)
* Fourth-nerve (IV)
* Sixth-nerve (VI)

Other strabismus|

* Esotropia / Exotropia
* Hypertropia
* Heterophoria
* Esophoria
* Exophoria
* Cyclotropia
* Brown's syndrome
* Duane syndrome

Other binocular|

* Conjugate gaze palsy
* Convergence insufficiency
* Internuclear ophthalmoplegia
* One and a half syndrome

Refraction|

* Refractive error
* Hyperopia
* Myopia
* Astigmatism
* Anisometropia / Aniseikonia
* Presbyopia

Vision disorders
Blindness|

* Amblyopia
* Leber's congenital amaurosis
* Diplopia
* Scotoma
* Color blindness
* Achromatopsia
* Dichromacy
* Monochromacy
* Nyctalopia
* Oguchi disease
* Blindness / Vision loss / Visual impairment

Anopsia|

* Hemianopsia
* binasal
* bitemporal
* homonymous
* Quadrantanopia

subjective|

* Asthenopia
* Hemeralopia
* Photophobia
* Scintillating scotoma

Pupil|

* Anisocoria
* Argyll Robertson pupil
* Marcus Gunn pupil
* Adie syndrome
* Miosis
* Mydriasis
* Cycloplegia
* Parinaud's syndrome

Other|

* Nystagmus
* Childhood blindness

Infections

* Trachoma
* Onchocerciasis

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