One of the most common ophthalmic symptoms in the middle and old-age people is increased pressure behind the eyes, which is also called as raised intraocular pressure in clinical terminology. This may present signs of headache, vertigo, difficulty in vision, pulsating feeling in the eye, etc. and lead to the disease of glaucoma. There are various factors leading to the development of this pressure and persistent raised intraocular pressure may result in some severe permanent damages leading to complete loss of vision or blindness. So, it becomes imperative to know about the intraocular pressure or pressure behind the eye.
What is Intraocular Pressure?
The pressure felt by the layers of the eyeball due to presence of intraocular fluids is known as IOP or intraocular pressure. These fluids are secreted by the ciliary processes behind the iris and drained through the trabecular flow and uveoscleral flow. Though the normal IOP ranges between 10 and 21 mmHg or 16 ± 2.5 mm of Hg yet, any disturbance in secretion or drainage or bath can lead to additional accumulation of fluid inside the chamber resulting in increased intraocular pressure. This can be managed medically as well as surgically but before that we have to understand what causes pressure to rise.
Causes of Increased Pressure behind the Eye
Rate of fluid formation directly affects IOP. The formation of aqueous humor also depends on other factors like permeability of capillaries and hemodynamic osmolarity.
Resistance in drainage or outflow. Clinically, restricted outflow is the most important factor. Generally, this resistance forms at the network of trabecular meshwork.
Raised episcleral venous pressure is directly proportional to increased intraocular pressure. This pressure can be increased temporarily by Valsalva maneuver.
Refractive errors such as myopia may raise the IOP due to relative obstruction of the iris compromising drainage of the fluid.
- Age. People above 40 years.
- Sex. More in females of age >40 years.
- Diurnal variation of IOP.
- Postural variation.
- Blood pressure.
- General anaesthetics and intoxicant materials.
- Exercise. It tends to decrease IOP temporarily.
How Do You Get Rid Of Pressure Behind Your Eye?
Proper management should be done to decrease pressure behind the eye ball. Before starting any clinical method of treatment it is necessary to consider some pre-medication profiling.
Grading of severity and baseline evaluation of glaucoma – Motive behind this treatment is to lower the intraocular pressure in order to prevent further loss of vision. It means that treatment requires care and has to be done under regular supervision of medical practitioner. To ensure the treatment is working, a baseline examination is carried before starting the treatment. This include: examination of anterior chamber, visual acuity, thickness measurement of central cornea, tonometry, and evaluation of optic disc, visual field charting and gonioscopy.
Grading can be done according to (AAO).
Choices of Therapy
- Medical therapy.
- Diode laser trabeculoplasty.
- Argon laser trabeculoplasty.
- Filteration surgery.
Although there is none compelling treatment regime exist. Following regimes can be taken into consideration-
Single Drug Therapy. Drugs for glaucoma are used. These include-
- Prostaglandin analogues. Lantanoprost (0.005%), Travoprost (0.004%), Bimatoprost (0.03%), Unoprost (0.15%).
- Beta blockers (topical). These are drug of choice in primary open angle glaucoma. Timolol maleate (0.25%, 0.5%), Betaxolol (0.25%), Levobunolol (0.25%, 0.5%), Carteolol (1%).
- Adrenergic drugs. Epinephrine hydrochloride (0.5%, 1%, 2%), Dipivefrin hydrochloride (0.1%), Brimonidine (0.2%).
- Pilocarpine (1%, 2%, 4%).
Combination Therapy (Topical). Timolol + β-blocker or brimonidine (+ lantanoprost or pilocarpine).
Carbonic Anhydrase Inhibitors (Oral). Acetazolamide (250 mg tds), Methazolamide. They are forbidden to recommend for long term consumption.
Hyperosmotic Agents. Mannitol (1-2 gm/kg of body weight).
Neuroprotective Agents. It is a method to treat damaged retinal ganglionic cells.
- ALT (Argon laser trabeculoplasty).
- DLT (Diode laser trabeculoplasty).
- SLT (Selective laser trabeculoplasty).
- Trabeculectomy. Most commonly employed surgical method.
- Filtration operation.