Ocular Hypertension

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What is Ocular Hypertension?

If you have ocular hypertension, you have a build-up of pressure inside the eye. This intraocular pressure is higher than average (measured in mmHg). 

When the front of the eye does not allow for proper fluid drainage, eye pressure increases. The elevated pressure can result in glaucoma. Glaucoma is an eye condition in which the optic nerve becomes damaged and vision loss occurs. In many cases of glaucoma, this damage may result from high eye pressure.

However, ocular hypertension is not the same as glaucoma. Although you may have raised pressure, standard tests may not find any signs of structural or functional damage. This is how ocular hypertension is distinguished from glaucoma, as glaucoma shows optic nerve damage. 

Nevertheless, people with ocular hypertension face a higher risk of developing glaucoma. 

Ocular hypertension is a leading risk factor for primary open-angle glaucoma (POAG)

What are the Symptoms of Ocular Hypertension?

Many people with ocular hypertension do not have any symptoms. For this reason, you should undergo regular eye exams to rule out the condition and minimize the likelihood of optic nerve damage. 

If you have ocular hypertension, you are at risk of glaucoma. Glaucoma is an eye disease that can lead to blindness.

5 Causes & Risk Factors of Ocular Hypertension

There are five primary reasons that ocular hypertension can occur:

  1. Fluid accumulation in the eye. An increased amount of aqueous humor (eye fluid) can raise intraocular pressure. 
  2. Inadequate aqueous drainage. Due to structural differences in the eye, drainage channels may not correctly release the build-up of fluid. An example of this may be pigmentary glaucoma, a type of glaucoma in which pigment in the eye clogs the drainage angle.
  3. Certain medications. Corticosteroids and other drugs like tricyclic antidepressants may increase eye pressure. 
  4. Eye trauma. Damage to the eye caused by an accident or infection.
  5. Specific risk factors. Race, age, and family history may influence whether a person develops ocular hypertension or not. People with extreme nearsightedness (myopia) or diabetes are at risk of this condition. 

Ocular hypertension occurs more often in African Americans, people aged 40 and up, and those with a family history of ocular hypertension and/or glaucoma. 

How is Ocular Hypertension Diagnosed?

First, ocular hypertension will not show any noticeable signs or symptoms. A comprehensive eye examination can help ophthalmologists perform a proper diagnosis and rule out any possible structural damage to the eye or other causes. 

In these types of examinations, an ophthalmologist may assess the following:

  • Visual acuity and visual fields 
  • Optic nerve damage (using keratometry readings)
  • Signs of pigment dispersion, pseudoexfoliation, iritis, or trauma (using a slit lamp)

Ophthalmologists sometimes perform gonioscopy (to check the eye’s drainage angle) and assess for angle closure. Finally, they may also evaluate central corneal thickness. 

Approximately 1 to 2% of patients with ocular hypertension will progress to primary open-angle glaucoma annually.

Treatment Options for Ocular Hypertension

Treatment options for ocular hypertension are available. However, an eye doctor may consider many different factors when determining the most suitable treatment, including:

  • Risk of progression to glaucoma 
  • Patient’s attitude about treatment
  • Patient’s age, health, and life expectancy

Low-risk patients do not need treatment (in most cases). But some moderate-to-high-risk patients may benefit from preventive treatment.

A randomized trial called the Ocular Hypertension Treatment Study (OHTS) showed that medical treatment of ocular hypertension lowered the risk of progression to glaucoma by 50% compared to no treatment. This study was performed at 5- and 10-year follow-ups.2  

For people with ocular hypertension, medical treatment is the most common approach. An eye doctor may prescribe topical prostaglandin analogs or β-adrenergic antagonists.

An eye doctor may also consider argon laser trabeculoplasty or selective laser trabeculoplasty in other cases. 

Both types of laser trabeculoplasty aim to ease and increase fluid outflow through the trabecular meshwork to decrease eye pressure. Selective laser trabeculoplasty is more commonly used as it is less destructive to the tissue.

The trabecular meshwork is the area of tissue in the eye found near the base of the cornea. Its primary function is to allow the aqueous humor to flow out from the eye via the anterior chamber (the chamber at the front of the eye covered by the cornea). 

To minimize the likelihood of progression to glaucoma or slow the onset of the disease, you should maintain follow-up visits. The frequency of these visits may vary according to intraocular pressure reduction. 

For example, if you reach your target intraocular pressure reduction, you may only need to visit the eye clinic every 6 to 12 months. However, if you don’t, you may need a follow-up examination every 3 to 6 months. Your eye doctor will advise you based on your clinical history and changes in eye health. 

Home Remedies for Ocular Hypertension

You cannot prevent ocular hypertension. Your eye doctor may prescribe medications to treat the condition. It is important to follow these treatments and attend all follow-up visits. When you do this, you decrease the risk of eye health complications, such as progression to glaucoma. 

The following list details some actions that you can implement to help reduce your risk for glaucoma:

  • Eat a rich and healthy diet with minerals like zinc and selenium and vitamins like A, E, and C
  • Raise your head to an approximately 20-degree angle while sleeping 
  • Drink small amounts of liquid (less than a quart) throughout the day 
  • Exercise regularly
  • Reduce your caffeine intake 
  • Learn and practice relaxation and mindfulness techniques 

What is the Prognosis for Ocular Hypertension?

The prognosis for ocular hypertension is favorable

To lower your chances of either progression to glaucoma or severe complications, you should maintain follow-up visits and adhere to prescribed medical treatments. 

Although glaucoma cannot be prevented in all cases, regular follow-up visits can detect early damage to the optic nerve and control further progression.

Glaucoma is the second most frequent cause of blindness in the world. 

Can You Prevent Ocular Hypertension?

You cannot prevent ocular hypertension. However, treatments are available to help reduce eye pressure. 

You must attend frequent visits and undergo clinical eye examinations to monitor any possible progression to glaucoma. An eye doctor will adjust treatment accordingly and slow the progression of the disease in its early stages.

Questions to Ask Your Eye Doctor

Here are some questions to ask your eye doctor about ocular hypertension:

How serious is ocular hypertension?

In some cases, ocular hypertension can become serious (if left untreated). It is important to maintain visits and follow treatment regimens to prevent progression to glaucoma or any damage to the eye. 

Can ocular hypertension be cured?

According to the American Optometric Association (AOA), there is no cure for ocular hypertension. You can decrease the chances of eye damage by following the treatments prescribed and visiting your eye clinic regularly. Monitoring your condition can help lower your risk of progression to glaucoma. 

Is ocular hypertension caused by high blood pressure?

People with high blood pressure or diabetes are at risk of developing ocular hypertension. 

Does sleep position affect eye pressure?

Yes. Your sleep position can affect eye pressure. To lower intraocular pressure, you should raise your head at a 20-degree angle. 

How can I lower my eye pressure fast?

Do not drink more than a quart or more of any liquid within a short time. This could cause your eye pressure to go up. Also, if you experience high stress levels, you may want to consider integrating relaxation and meditation exercises. Finally, you may also need to eliminate certain medications, such as antihistamines. You must speak with your doctor before removing any daily care medication. 

Does caffeine increase eye pressure?

Yes. Caffeine can contribute to increased eye pressure. If you are drinking large amounts of coffee or energy drinks, you should reduce your caffeine intake. 

What foods help eye pressure?

It is important to follow a healthy diet. Improved eating habits can contribute to lower stress levels and blood pressure, as well as better sleep. A healthy diet includes meals that provide antioxidants, vitamins A, E, and C, and minerals like zinc, copper, and selenium.

Resources
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Boyd, K. (2021, March 9). What Is Ocular Hypertension? American Academy of Ophthalmology.

Kass, M. A. (2002, June 1). The Ocular Hypertension Treatment Study. Archives of Ophthalmology.

Ocular Hypertension Treatment. Glaucoma Research Foundation. (n.d.).

Ocular hypertension. AOA.org. (n.d.).

Pitha, I., & Kass, M. (2014, September 2). Ocular Hypertension. Glaucoma (Second Edition).

Your Eye Concerns. Bausch + Lomb. See better. Live better. (n.d.).

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