Ocular Hypertension: A Misdiagnosis? or a Precursor to Glaucoma?

Generally increase in pressure is not good for our bodies, things ought to always be in moderation when it comes to our anatomy and physiology and so when pressure spikes, things tend to go wrong and does so at quite a fast rate too. And so an individual with hypertension could easily lose consciousness if it goes too high.

Similarly, when things are too low it is equally devastating, and so systemically hypotension could even be more deadly as compared to hypertension, basically what I am trying to arrive at is that having high pressure within any part of the body is bad and should be dealt with accordingly.

Now when it comes to the eye, almost all cases associated with high intraocular pressure are directly attributed to glaucoma and this shouldn't be so. A lot of times patients misdiagnose themselves just because they hear the words pressure on the eye and start to see themselves as glaucoma patients, spreading the word around and getting treated wrongly. And so today, I hope to throw some light on these instances or situations and get us on track with ocular hypertension.

When the eye's pressure goes up it is referred to as ocular hypertension, just like its name suggests. Now your eye's pressure going up doesn't automatically put you in the position as a patient with ocular hypertension the same way your systemic pressure rising acutely doesn't automatically make you a hypertension patient.

Our systems are not fixed, they are flexible, they swing between ranges, things move up and down, and on some occasions out of range when these moments come they do not define our entire well-being or health. For there to be a definite diagnosis repetitive results would have to come up.

And so you could have your systemic pressure quite up after walking quite a distance to perhaps reach the hospital, in that instance, you would be asked to rest a while and after checking again, it should be back to normal however if the pressure is outrageously high, you may be given medications to facilitate the normalization but this still doesn't qualify you as a hypertensive patient unless your pressure continues to stay up over some time even when you haven't done strenuous activities.

It is the same with the eye, some activities could cause an acute rise in intraocular pressure, and some underlying conditions can also cause an acute rise in intraocular pressure. Even the time of the day can affect your intraocular pressure measurement and so if you happen to visit the hospital and your Optometrist tells you that your pressure is quite high do not assume he means you have glaucoma, he could literally be referring to your intraocular pressuring rising acutely.

He may ask you to go and come back or wait for the pressure to be checked again after a while however if it is quite outrageous then he may give you medication just to aid the normalization but that doesn't mean you have ocular hypertension unless it continues to stay up over a period after other test are also done to confirm. Now even when you get a definite diagnosis of ocular hypertension it doesn't qualify you as a glaucoma patient, at least not yet if I can put it that way. Why do I say that?

So lemme try to explain with another example from systemic hypertension. Now when one becomes hypertensive they are prone to a lot of other health complications most of which focus on the cardiovascular system because that's where the condition stems from. And so if your systemic pressure continues to stay high for a long time it could expand your heart muscles, put extra stress on them and cause them to become weak.

Your heart could get enlarged and it could also fail from the extra stress or just die off, I am certain we are all familiar with the term heart attack, cardiac arrest, or myocardial infarction for those who are more technical. This is just an example of us many other complications arise from hypertension. Such is the way of ocular hypertension and unfortunately, the most likely complication, in this case, is the development of glaucoma.

The issue with glaucoma is that aside from the fact that it is basically idiopathic anatomically it could have so many causes, including conditions such as uveitis, trauma, etc resulting in glaucoma. Even your intraocular lens displacement could result in glaucoma. And so when your intraocular pressure continues to stay up for quite a while, the pressure, directly and indirectly, ends up killing the optic nerve cells, pushing them further back resulting in optic atrophy.

As the cells die the disc now takes up the glaucomatous damage appearance and once the cells start dying they follow this automated system where one cell's death triggers the other beside it and they keep going off until nothing is left. This is exactly how glaucoma works, but then it didn't start off as glaucoma initially, it started off as a high IOP without any glaucomatous accompaniment.

And so that is how Ocular Hypertension could be a precursor to Glaucoma, but note that this would only happen if we fail to control the pressure accordingly or the patient fails to follow instructions with regards to their medication in controlling the pressure. And so it boils down to both the clinician and the patient doing their part well to ensure that it doesn't come to that.

And so please be mindful of how you throw the words of your Optometrist around to another health practitioner lest you misdiagnose yourself and end up with a treatment you weren't meant to have in the first place. This is why I keep on hammering on the need to ask when in doubt, this is very important and can clear up a lot of confusion as well as ensure the right things are done.

Take your ocular health serious, take your treatment plans seriously, ask if you are confused about your diagnosis or medication, and ensure that things are cleared up for you so you could also do your part for your own health. Do well to avoid over-the-counter medication without proper care as you could be setting yourself up for vision loss and finally, do well to have regular eye exams. Once again, it was a pleasure serving you and I look forward to another beautiful time with you. Ciao.