Diagnostic Considerations

Repeat tonometry readings should be taken over time and considered with correlative results of visual field testing, optic nerve examination, and pachymetry measurements before diagnosis or therapy is rendered.

Differential Diagnoses

Angle-Recession Glaucoma
Drug-Induced Glaucoma
Acute Angle-Closure Glaucoma (AACG)
Primary Angle-Closure Glaucoma
Hyphema Glaucoma
Intraocular Tumors and Glaucoma
Lens-Particle Glaucoma
Neovascular Glaucoma
Ocular ischemic syndrome
Peripheral anterior synechia
Phacolytic Glaucoma
Phacomorphic Glaucoma
Pigmentary glaucoma
Plateau iris glaucoma
Posner-Schlossman syndrome
Primary open-angle glaucoma
Pseudoexfoliation glaucoma
Suspect glaucoma
Uveitic glaucoma

Workup

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Media Gallery

Diagram of intraocular pressure distribution. Used with permission from Survey of Ophthalmology.
Flowchart for evaluation of a patient with suspected glaucoma. Used by permission of the American Academy of Ophthalmology.
Diagram showing the relative proportion of people in the general population who have elevated pressure (horizontally shaded lines) and/or damage from glaucoma (vertically shaded lines). Notice that most have elevated pressure but no sign of damage (ie, ocular hypertensives), but there are those with normal pressures who still have damage from glaucoma (ie, normal tension glaucoma). (Diagram used by permission of M. Bruce Shields.) OHT = horizontal lines only NTG = vertical lines only POAG and other glaucomas with both elevated intraocular pressure and damage = overlapping horizontal and vertical lines
Humphrey visual field, right eye, showing patient with advanced glaucomatous field loss. Notice both the arcuate extension from the blind spot (Bjerrum scotoma), as well as the loss nasally (nasal step), which often occurs early in the disease process. Courtesy of M. Bruce Shields.
Illustration of progressive optic nerve damage. Notice the deepening (saucerization) along the neural rim, along with notching and increased excavation/sloping of the optic nerve and circumlinear vessel inferiorly. Courtesy of M. Bruce Shields.
Example of progressive visual field loss over time (from top to bottom) in a patient with glaucoma. Notice the early appearance of an inferior nasal step and arcuate loss, with progressive enlargement and increasing density of the scotomata over time. Humphrey visual field courtesy of M. Bruce Shields.
Example of optic nerve asymmetry in a patient with glaucomatous damage, left eye, showing optic nerve excavation inferiorly similar to Image 5. Used by permission of M. Bruce Shields.
Glaucomatous optic nerve damage, with sloping and nerve fiber layer rim hemorrhage at the 7-o'clock position. Hemorrhage is indicative of progressive damage, usually due to inadequate pressure control. Further notching and pallor corresponding to the area of hemorrhage usually is seen several weeks after resorption of the blood. Courtesy of M. Bruce Shields.
Advanced glaucomatous damage with increased cupping and substantial pallor of the optic nerve head. Courtesy of M. Bruce Shields.
Correction values according to corneal thickness.
Ocular hypertension study (OHTS). Percentage of patients who developed glaucoma during this study, stratified by baseline intraocular pressure (IOP) and central corneal thickness (CCT).

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Ocular Hypertension Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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