Attempted eyelid closure affects intraocular pressure measurement in open-angle glaucoma patients

PURPOSE: To evaluate the effect of attempted eyelid closure on intraocular pressure (IOP) measurements in normal-tension (NTG) and high-tension (HTG) open-angle glaucoma patients. DESIGN: Prospective clinical trial METHODS: Forty randomly selected eyes of 40 patients underwent corneal pachymetry and IOP measurements using both Goldmann applanation tonometry and Tono-pen XL (Mentor, Inc., Norwell, Massachusetts, USA). Intraocular pressure was measured by the same examiner holding the eyelids open, both with and without the subject simultaneously attempting forced eyelid closure. Subjects were seated during all measurements and waited 5 minutes between measurements with each instrument; the order of measurement was randomized. RESULTS: Twenty NTG and 20 HTG eyes were enrolled. The mean age was 63.0 ± 13.0 years (range, 31-80 years). The average corneal thickness was 540 ± 32 μm (range, 480-608 μm) in NTG patients and 552 ± 40 μm (range, 449-610 μm) in HTG patients (P = .07, analysis of variance [ANOVA]). Using Goldmann applanation tonometry, IOP measurement in eyes with NTG increased by 3.9 ± 2.0 mm Hg with attempted eyelid closure (P < .0001, paired t test; range, 2-11 mm Hg). With the Tono-pen XL, IOP measurements increased 4.2 ± 2.7 mm Hg (P < .0001, paired t test; range, 1-14 mm Hg). With attempted forced eyelid closure, the Goldmann applanation measurement in eyes with HTG increased 4.1 ± 2.1 mm Hg (P < .0001, paired t test; range, 1-9 mm Hg). Using the Tono-pen XL, measurements increased 4.5 ± 2.0 mm Hg (P < .0001, paired t test; range, 2-11 mm Hg). CONCLUSION: Attempted eyelid closure during tonometry is a significant and common source of error in eyes with glaucoma and may influence the clinical management and decision-making in the treatment of NTG and HTG.