TONOMETRY

Manasa.N 2yr BS.c optometry NSO

CONTENTS

Introduction Indentation tonometry Schiotz tonometer Applanation tonometry Goldmann tonometer Perkins tonometer Tonopen Mackey marg tonometer Non contact tonometer

What is a tonometry???

Tonometry is the procedure, eye care professionals perform to determine the intraocular pressure (IOP). It is used to determine the pressure in the eye by measuring the firmness of its surface.

Why it is done.??

This test is used to check for Glaucoma. Glaucoma; Is an eye disease that can cause blindness by damaging the Optic nerve. Normal IOP ranges from 10 to 21mmHg

Indentation tonometry

If a plunger of known weight is rested on the cornea, the depth of plunger indentation should (?) be proportional to IOP.
Plunger is connected to lever arm and scale.

Schiotz tonometer

The footplate is rested on the cornea and the plunger is free to indent the cornea. A variety of weights may be used to minimise errors due to corneal rigidity. (use with tables)

Advantages Simple technique Portable No need for SL Reasonably priced

Disadvantages
Corneal abrasions more likely. Effect of corneal rigidity on reading

Applanation tonometry

Basis : Imbert-fick law. For an ideal dry, thin walled sphere, the pressure inside the sphere (p) is equals the force (F) required to flatten its surface, divided by the area of flattening (A): P = F/A or F = PA

Applanation tonometer

Goldmann - The pressure which is required to flatten the cornea gives the IOP only if the applanated cornea ranges from 2.5 to 4 mm. It is in this range that the adhesive forces of tears and the force necessary to overcome the rigidity of the cornea are in balance.

A Goldmann Tonometer

Slit lamp of goldmann tonometer

Mires seen during goldmann tonometry through slit lamp

Advantages
Easy to use cheap comfortable (apart from anaesthetic) Quick

Disadvantages

Need for anaesthetics Cannot be delegated Contact with cornea (slight chances of abrasion

Perkins Tonometer

It uses the biprism as the Goldmann applanator. The light source is powered by battery, and a counter balance enables the instrument to be used in both the vertical and horizontal positions. The readings are consistent and compare quite well with the Goldmann applanator.

Perkins tonometer

The readings are consistent and compare quite well with the Goldmann applanator.

Tonopen

Tonopen measured an average of 1.7 mm higher than the Goldmann tonometer. Easier to use with corneal abnormalities. Patient can be lying or sitting.

Tonopen

A sterile cover must be over the tip. Ensure patient has anaesthetic, gently tap tonopen against cornea. Final averaged reading (of usually 4 6) is displayed

Mackay-marg tonometer

It applanates the cornea via a plunger that moves within a sleeve, similar in fashion to a Schitz tonometer. The plunger is electronically coupled to a transducer and graphically records the movement of the plunger on a moving strip of paper. The plunger first indents the cornea recording on the graph paper, the sum of the force required to flatten the cornea and the IOP.

Mackay-marg tonometer

The pressure tracing then decreases to a level that represents the IOP.
Because the tonometer records instantaneously, multiple readings should be averaged in order to adjust for fluctuation in pressure due to the ocular pulsation.

It is especially useful in edematous or irregular corneas.

Non contact tonometer

Noncontact (or air-puff) tonometry does not touch your eye but uses a puff of air to flatten your cornea.

This type of tonometry is not the best way to measure intraocular pressure. But it is often used as a simple way to check for high IOP and is the easiest way to test children.

Non contact tonometer

Advantages of NCT

Corneal applanation is produce by air pulse. No topical anaesthetic No risk of infection No corneal abrasion Good for population screening Good results Costly equipment

Questions...???

Thank you