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Ophthalmic Images |

Overestimation of Intraocular Pressure by Goldmann Applanation Tonometry Without Astigmatic Correction Online Only

Rosalind M. K. Stewart, FRCOphth, PhD1,2; Peter K. Wishart, FRCOphth1; Stephen B. Kaye, FRCS, FRCOphth, MD1,2
[+] Author Affiliations
1St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, England
2Department of Eye and Vision Science, University of Liverpool, England
JAMA Ophthalmol. 2016;134(3):e153691. doi:10.1001/jamaophthalmol.2015.3691.
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This Ophthalmic Image shows marked overestimation of the intraocular pressure as measured with Goldmann applanation tonometry that was corrected by adjustment for the astigmatic error.

A man in his mid-50s underwent 2 successive emergency penetrating keratoplasties for Candidal keratitis in his left eye. Significant postoperative astigmatism (K1 = 34.7@117, K2 = 45.2@27) led to marked overestimation of the intraocular pressure (56 mm Hg) as measured with Goldmann applanation tonometry with the mires in the standard horizontal position (Figure, A). With astigmatic correction, rotating the mires to 43° with respect to the more weakly refracting meridian,1 the pressure measured 20 mm Hg (Figure, B), which was confirmed by rebound tonometry (17 mm Hg).

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Figure.

High corneal astigmatism after penetrating keratoplasty resulted in significant overestimation of the intraocular pressure by Goldmann applanation tonometry with horizontal mires (A), which was corrected by adjustment for the astigmatic error (B).

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