What is Ocular Hypertension?
- When the pressure inside the eye — known as intraocular pressure — gets too high, this is known as ocular hypertension.
- Elevated intraocular pressure does not cause vision loss, but people with the condition can develop glaucoma — a disease that damages the optic nerve and can result in blindness.
- Not all ocular hypertension patients develop glaucoma, as factors like age, race, and general health all play a role.
- Ocular hypertension is currently incurable, but the condition can be managed with lifestyle changes, medication, and surgical interventions.
What is Ocular Hypertension?
Ocular hypertension refers to high pressure inside the eye — this type of pressure is also referred to as high intraocular pressure (IOP).
The eye comprises two fluid-like substances — aqueous humor and vitreous humor — that supply the eye with nutrients and help it maintain its shape.
The aqueous humor – which is a watery substance – is constantly being produced and drained from the eye. When this drainage system is blocked or works inefficiently, the pressure in the eye increases. This results in ocular hypertension.
Ocular hypertension does not typically affect the appearance or function of the optic nerve (this is the nerve responsible for sending impulses from the eye to the brain so that we can see). Therefore, your field of vision is not affected by this condition.
However, ocular hypertension increases the risk of developing other eye diseases that may affect vision.
Is Ocular Hypertension a Serious Condition?
Ocular hypertension is a very serious condition that needs to be diagnosed and treated by an ophthalmologist (specialist eye doctor).
Even though ocular hypertension does not affect the optic nerve and can be successfully managed, people with the condition can develop glaucoma.
Ocular hypertension and glaucoma
Glaucoma is a severe eye condition that causes damage to the optic nerve, which can potentially lead to permanent vision loss. It's essential to seek treatment for this condition.
A long-term study conducted in the U.S. on people with high eye pressure found that 4.4% of participants on treatment for lowering eye pressure developed glaucoma after five years, while 9.5% of participants developed the condition without treatment.
The study also found that not all people with elevated eye pressure develop glaucoma — there are other risk factors that play a role, too. However, people diagnosed with ocular hypertension are at a higher risk of developing glaucoma and must regularly check in with their eye doctor and also follow any prescribed treatment plans.
People with high intraocular pressure are typically considered glaucoma suspects.
Glaucoma may also be called ‘the silent thief of sight’ as it damages the eye very slowly over time, and causes vision loss without any warning signs.
This is what makes regular eye exams so important — especially if you have a higher risk of developing glaucoma due to certain factors.
There are two main forms of glaucoma.
Primary angle-closure (PAC) or narrow-angle glaucoma
This is when there is an immediate shutdown of the spongy tissue that drains fluid from the eye, which results in increased fluid and pressure in the eye.
This should be treated as a medical emergency to avoid permanent vision loss.
Primary open-angle glaucoma (POAG) or open-angle glaucoma
This refers to a gradual blockage of the spongy tissue that drains fluid from the eye. Even though this is not an emergency, it should be addressed by your eye doctor.
POAG is strongly linked to high intraocular eye pressure, but it may also affect people with normal intraocular pressure.
Key Point: What is a Glaucoma Suspect?
A visit to the eye doctor will help them determine whether you’re a glaucoma suspect.
People who are glaucoma suspects have one or more of the following risk factors that greatly increase their chances of developing glaucoma:
- Ocular hypertension — also known as high intraocular pressure (IPO)
- An abnormal optic nerve (this may suggest optic nerve damage)
- Vision field defects that are characteristic of glaucoma
- Abnormalities in the eye’s drainage angle
- A family history of glaucoma and other risk factors
- Abnormalities in the retinal nerve fiber layer that suggests damage
What are the Causes and Risk Factors for Ocular Hypertension?
As mentioned earlier, ocular hypertension is caused by increased eye pressure that occurs due to aqueous humor (the watery-like substance that fills the space between the eyeball and lens) that doesn’t drain from the eye.
There are several factors that can increase your risk of elevated eye pressure. Listed below are some of the main reasons you can develop ocular hypertension:
- Age: People aged 40 or older have an increased risk of 4.5% to 9.4% of developing ocular hypertension.
- Ethnicity: Research shows that ocular hypertension seems to be more common among Hispanics and African Americans.
- Family history: A family history of hypertension, ocular hypertension, or glaucoma puts individuals more at risk.
- Pre-existing conditions: Hypertension and diabetes are health conditions that should be managed to decrease risk.
- Nearsightedness: Nearsighted individuals are more at risk of developing ocular hypertension.
- Medication: Certain nasal sprays or eye drops that contain steroids can increase risk. Certain antidepressants – like amitriptyline and paroxetine – are also linked to increased eye pressure and glaucoma risk.
- Trauma: Structural damage to the eye itself, whether due to injury or previous eye surgeries.
What are the Symptoms of Ocular Hypertension?
Much like glaucoma, ocular hypertension also has no obvious symptoms. Your optometrist will be able to determine if you have reason to be concerned.
Regular eye exams are the only way to identify ocular hypertension.
Some patients may report pain when they move their eye(s), but this symptom is not specific to ocular hypertension.
However, if your ocular hypertension turns into glaucoma, you may experience the following symptoms — or none at all, depending on the stage of your glaucoma:
Symptoms of primary angle-closure (these are emergency signs)
- Sudden severe eye pain and redness
- Nausea and vomiting when you experience the above
- Severe headache — especially around the forehead and the eyes
- Hazy or blurred vision
- Seeing bright rings or halos around lights
Symptoms of primary open-angle glaucoma
POAG starts slowly and people are unlikely to experience symptoms in the early stages. As the disease progresses, blind spots may appear in your peripheral vision (side vision).
How is Ocular Hypertension Diagnosed?
Ocular hypertension can be diagnosed by either an optometrist or an ophthalmologist.
In the past, doctors would measure intraocular pressure using the ‘air puff test’ — also known as noncontact tonometry (NCT).
During an NCT, a device would typically direct a puff of air onto the eye’s surface to measure the resistance of the eye to the air puff in order to determine the intraocular pressure.
These days, different methods are used to obtain more accurate pressure readings.
Tonometry is a diagnostic test used to measure the pressure in the eye.
First, eye drops are used to numb the eye. The ophthalmologist then uses a small instrument to apply pressure onto the surface of your eye to obtain a reading. This pressure reading is then compared to normal eye pressure for a diagnosis to be made.
This painless procedure takes only a few minutes.
Dilated eye examination (fundoscopy)
Eye drops are used to dilate (widen) your pupil, which is the small black center of your eye. Your doctor will then shine a light into your eye and examine your optic nerve for damage.
How is Ocular Hypertension Treated?
Ocular hypertension cannot be cured but it can be managed by using the following methods.
Self-care at home
Improving your diet, moving more, and breaking bad habits are all great ways to manage ocular hypertension.
You should maintain healthy blood sugar, blood pressure, and cholesterol levels by limiting your intake of starch, salt, and foods rich in saturated fats.
Also, remember to take regular readings and not miss your checkups — this is vital if glaucoma runs in the family.
Some more things you can do to improve your chances of living a healthy life without vision loss, include:
- Refraining from smoking and using recreational drugs
- Limiting caffeine and alcohol intake
- Keeping stress levels low by making time for the things you love, like painting, drawing, walking, reading, or meditation
Protecting your eyes
Everyone should be prioritizing their eye health, but people at risk for developing glaucoma should take extra precautions, including:
- Wearing sunglasses to keep ultraviolet (UV) light out
- Practicing good hygiene when handling your contact lenses (if you wear them) to prevent eye infections
- Following the 20-20-20 rule to prevent eye strain: For every 20 minutes of work, take a break and look at something 20 feet away, for 20 seconds
Managing existing health conditions
Be sure to take your medication on time, each day, and to have regular checkups so your doctor can monitor your condition and adjust your medication accordingly.
You should also avoid non-prescription decongestant agents such as pseudoephedrine (Sudafed, Dimetapp) and phenylephrine (Sudafed PE).
Remember, many non-prescription cold and flu medications contain the above mentioned agents. Speak to your pharmacist to help find the right medication for you.
Your doctor may prescribe medication to help manage ocular hypertension. As part of your doctor’s plan, they may recommend one or more of the following treatments:
- Prescription eye drops: These either reduce the amount of fluid inside the eye to allow more drainage time, or they encourage drainage from the eye to account for incoming fluid.
- Beta-blockers: These medications help by decreasing the production of aqueous humor in the eye. These are usually given in the form of eye drops and include timolol (Betimol) or betaxolol (Betoptic).
- Prostaglandins: These drugs lower the pressure in the eye to prevent further damage. An example is bimatoprost (Lumigan).
- Alpha agonists: These are alternative medications that can be used if you’re allergic to prostaglandins — for example, brimonidine (Alphagan).
- Pilocarpine: This drug helps increase the rate at which fluid drains from the eye.
- Nitric oxides: These are shown to slow down the progression of ocular hypertension to glaucoma by decreasing intraocular pressure and increasing blood flow to the optic nerve.
- Other medications: Acetazolamide (Diamox) is a tablet used to reduce pressure in the eye.
Surgical interventions are rare for treating ocular hypertension, but they may be necessary in some cases.
If medication is not working to resolve or manage ocular hypertension and prevent glaucoma, your ophthalmologist might take a surgical route.
This procedure uses laser treatment to eliminate blockages in the spongy tissue that drains fluid from the eye. This increases fluid drainage and reduces pressure in the eye. It is used primarily in the treatment of open-angle glaucoma (OAG) and ocular hypertension.
How Can I Prevent Ocular Hypertension?
There are several things you can do to decrease your chances of developing ocular hypertension. Many of these strategies can also be used to manage the condition if you’ve been diagnosed with it.
- Do not miss your regular doctor’s checkups and eye examinations
- Keep yourself healthy by staying fit and active
- Eat healthier by reducing salt, saturated fat, and sugar in your diet
- Take steps to prevent high blood pressure and diabetes
How often should I go for follow-ups if I have ocular hypertension?
The frequency of your follow-ups with your doctor may vary. Your ophthalmologist, their method of treatment, and the severity of your ocular hypertension will determine how often you will need to see your doctor.
Where Can I Learn More About Ocular Hypertension and Eye Health?
When was your last eye exam? Don’t wait until vision problems start and you’re forced to seek help. Regular eye examinations are important and LifeMD can help get you back on track with these crucial checkups.
It’s never too early to take steps to prevent vision loss. Schedule an appointment with a medical healthcare professional through LifeMD to get started.