I have pressure in my right eye; how should I manage it?

Management of Right Eye Pressure

You need immediate ophthalmologic evaluation to determine whether this represents elevated intraocular pressure (IOP) from glaucoma or acute angle closure, as both require urgent but different treatments. 1

Immediate Assessment Required

Your ophthalmologist must perform these specific evaluations:

• Measure IOP using Goldmann applanation tonometry - Normal is 10-21 mmHg; elevated pressure (≥24 mmHg) indicates ocular hypertension or glaucoma 1, 2
• Perform gonioscopy in a dark room to assess if your anterior chamber angle is open or closed - this determines whether you have open-angle or angle-closure disease 1, 3
• Examine your optic nerve for glaucomatous damage (cupping, rim thinning, hemorrhages) 1
• Check for acute angle closure signs: mid-dilated pupil, corneal edema (causing blurred vision or halos around lights), red eye, severe pain, nausea/vomiting 1, 4

If Acute Angle-Closure Crisis is Diagnosed

This is a true emergency requiring immediate treatment:

Immediate medical therapy (all administered together):

• Topical beta-blockers, alpha-2 agonists, and carbonic anhydrase inhibitors 4, 5
• Oral or IV acetazolamide 500 mg initially, then 250 mg every 4 hours 5
• Oral or IV hyperosmotic agents for rapid IOP reduction 4

Definitive treatment once corneal clarity permits:

• Laser peripheral iridotomy (LPI) to relieve pupillary block 1, 4
• Prophylactic LPI in your fellow (left) eye, as approximately 50% of fellow eyes develop acute angle closure within 5 years 4

If Primary Open-Angle Glaucoma or Ocular Hypertension is Diagnosed

Medical treatment is indicated if you meet these criteria:

• IOP between 24-32 mmHg with risk factors for progression 1, 2
• Goal is to reduce IOP by 20% or achieve IOP ≤24 mmHg 1, 2

Treatment reduces risk: The Ocular Hypertension Treatment Study demonstrated that topical ocular hypotensive medication reduced the 5-year risk of developing glaucoma from 9.5% to 4.4% (60% risk reduction) 2

Target IOP adjustment:

• Lower the target if you show progressive optic nerve or visual field damage despite treatment 1
• Consider raising target if stable on treatment with medication side effects 1

Critical Timing Considerations

• IOP fluctuates throughout the day - highest in morning, lowest in early afternoon 6
• A single afternoon measurement may miss elevated pressure peaks 6
• Diurnal IOP curves (measurements every 2 hours throughout the day) are mandatory for accurate risk assessment 6

Common Pitfalls to Avoid

• Do not delay evaluation - sudden vision loss or severe symptoms require same-day ophthalmologic assessment 7
• Chronic miotic therapy is NOT an appropriate alternative to laser iridotomy for angle closure - approximately 40% of eyes treated with miotics alone still develop acute angle closure within 5 years 4
• Do not assume normal pressure from one measurement - you need multiple measurements at different times of day 6

Follow-Up Requirements

• Regular monitoring with repeat gonioscopy to detect increasing peripheral anterior synechiae 4
• Visual field testing and optic nerve imaging to detect progression 1
• Adherence to medications is critical - poor adherence is a major risk factor for progression 1