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    Tonometry: DR - Mehreen Afzal PGR Eye Unit Ii

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    Usman Imtiaz
    Tonometry is used to measure intraocular pressure through applanation or indentation techniques to help detect glaucoma, ocular hypertension, and hypotony. The Goldmann applanation tonometer is the most common method but other options like Perkins, pneumatic, Tono-Pen, non-contact, and Schiotz indentation tonometers can also be used depending on the setting and patient. Proper technique and disinfection of tonometer tips is important for accurate measurements.

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    Tonometry: DR - Mehreen Afzal PGR Eye Unit Ii

    Uploaded by

    Usman Imtiaz
    106 views34 pages
    Tonometry is used to measure intraocular pressure through applanation or indentation techniques to help detect glaucoma, ocular hypertension, and hypotony. The Goldmann applanation tonometer is the most common method but other options like Perkins, pneumatic, Tono-Pen, non-contact, and Schiotz indentation tonometers can also be used depending on the setting and patient. Proper technique and disinfection of tonometer tips is important for accurate measurements.

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    Tonometry

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    Tonometry is used to measure intraocular pressure through applanation or indentation techniques to help detect glaucoma, ocular hypertension, and hypotony. The Goldmann applanation tonometer is the most common method but other options like Perkins, pneumatic, Tono-Pen, non-contact, and Schiotz indentation tonometers can also be used depending on the setting and patient. Proper technique and disinfection of tonometer tips is important for accurate measurements.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    106 views34 pages

    Tonometry: DR - Mehreen Afzal PGR Eye Unit Ii

    Uploaded by

    Usman Imtiaz
    Tonometry is used to measure intraocular pressure through applanation or indentation techniques to help detect glaucoma, ocular hypertension, and hypotony. The Goldmann applanation tonometer is the most common method but other options like Perkins, pneumatic, Tono-Pen, non-contact, and Schiotz indentation tonometers can also be used depending on the setting and patient. Proper technique and disinfection of tonometer tips is important for accurate measurements.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 34

    Tonometry

    Dr.Mehreen Afzal
    PGR EYE UNIT II
    Introduction

    • Tonometry is the measurement of Intra ocular pressure.

    • It is performed as a part of thorough ocular examination to help


    detect:
    • Ocular hypertension

    • Glaucoma

    • Ocular hypotony
    Types Of Tonometers

    Tonometer

    Applanation Indentation
    Applanation Tonometers

    • Applanation tonometer measure the force need to flatten, or

    applanate,a small area of the central cornea.

    • The greater the force needed to applanate a known area of cornea,

    the higher the IOP.


    Types Of Applanation Tonometers

    • Goldmann applanation tonometer

    • Perkins tonometer

    • Pneumatic tonometer

    • Tono-pen applanation tonometer

    • Non-contact tonometer
    Goldmann Applanation Tonometer

    • The most common tonometer

    • Usually mounted on a slit-lamp biomicroscope

    • Advantage:
    • Measures IOP of a seated patient with high accuracy

    • Disadvantage:
    • Less precise for edematous and scarred cornea

    • Not useful at bed side


    Goldmann Applanation Tonometry Parts
    Performing Goldmann Applanation
    Tonometry
    Instrument setting:
    • Insert a clean tonometer tip in the biprism holder

    • Align the 180◦ marking on the tonometer tip with white line on
    biprism holder

    • Instill a topical anesthetic drop and Fluorescein dye into each of the
    patient's eye
    Continued

    • Position cobalt filter in front of the slit lamp illumination device

    • Set the magnification at lower power and high light intensity shining on
    the tonometer tip at angle 60◦

    • Align the tonometer tip with patient’s cornea by using slit lamp control
    handle
    Seating Of Patient

    • Seat the patient at slit lamp with the patient forehead firmly against
    the headrest and chin on chin rest

    • Instruct patient to focus on your right ear , blink once and then try to
    avoid blinking
    Method To Perform

    • Using the slit lamp control handle, gently move the biprism forward until it
    touches the cornea

    • Fluorescein spot will break into two semicircles

    • Raise and lower the slit lamp until the semicircles are equal in size

    • Slowly and gently turn the force adjustment knob in the direction required to
    move the semicircles until their inner edges just touch and do not overlap
    View Through Biprism
    Continued..

    • Pull the tonometer tip away from patient’s eye

    • Note the reading on the numbered dial of the force adjustment knob

    • Multiply the No by 10 to obtain IOP in mmHg

    • Repeat the procedure for the left eye


    Disinfecting The Tonometer Tip

    • Remove the tonometer tip from the holder after use

    • Disinfect by 1 one of the following mechanism:


    • Swab the tip with an alcohol swab

    • Soak the tip in a 10% solution of sodium hypochlorite or 3% hydrogen


    peroxide for 10 minutes

    • Rinse the tonometer tip with water and dry with tissue or gauze
    Perkins tonometer

    • It’s a handheld, portable device

    • The technique, mechanism of action and relative accuracy is similar to goldmann


    tonometer

    • Advantage:
    • It is useful at the bedside or in the operating room

    • Disadvantage:
    • Steadiness of both the patient and examiner are hard to control
    Pneumatic Tonometer

    • Its an electronic pressure-sensing device

    • Consists of a gas filled chamber covered with Silastic diaphragm

    • The gas escapes through an exhaust vent

    • As the diaphragm touches the cornea, gas vent is educed in size and pressure

    in chamber rises
    Pneumatic Tonometer

    • Advantage:

    • Its portable , can be used with seated or supine patient

    • Useful in the presence of corneal scars and edema


    Pneumatic Tonometer
    Tono-Pen Applanation Tonometer

    • Portable electronic applanating device

    • It produces an electric signal as the tip of tono-Pen applanates the cornea

    • Advantage:
    • Uses disposable sterile rubber covers for tip

    • Can be used for seated or supine patients

    • Useful in the presence of corneal edema and scars


    Tono-Pen Applanation Tonometer
    • Disadvantage:

    • It underestimates IOP in the higher ranges

    • Its accuracy is not high


    Tono Pen Applanation Tonometer
    Non-contact Tonometer

    • Determines IOP by measuring the time necessary for a given force of


    air to flatten a given area of cornea

    • Advantage:
    • No anesthetic drops needed

    • Disadvantage:
    • Gives false results at high and low extremes of IOP
    Indentation Tonometer
    • Indentation tonometer measure the amount of indentation of the
    cornea produced by a known weight
    Schiotz Tonometer
    • Advantages:
    • Inexpensive

    • Portable

    • Easy to use
    Schiotz tonometer
    • Disadvantages:
    • Limited accuracy in:

    • High myopia

    • Prior ocular surgery

    • Corneal edema

    • incorrect technique, inadequate cleaning, improper calibration


    Parts Of Schiotz Tonometer
    Performing Schiotz tonometry

    • Check for proper calibration of the instrument

    • Instill a drop of topical anesthetic onto each of the patient’s eye

    • Place a 5.5 g weight on the schiotz tonometer

    • Position the patient supine on tilted back in the examination chair and
    fixating on the ceiling
    Performing Schiotz tonometry

    • Grasp the handles of tonometer with the thumb and index finger of
    your dominant hand and align the scale so it faces you

    • Maintaining the instrument in vertical orientation, gently lower it on


    patient’s cornea until the foot plate is resting on the cornea

    • Read the scale and lift the instrument straight up and off the patient’s
    eye
    Performing schiotz Tonometry

    • Using the calibration table that comes with the instrument, determine
    the IOP in mmHg

    • If the scale reading is less than 4,add 7.5kg weight and repeat the
    measurement

    • Repeat steps for the left eye

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