Screening of intraocular pressure before routine pupil dilation for retinal photography: Clinical case report

Introduction: Pharmacologic dilation of the pupil results in twice the sensitivity of detection of diabetic retinopathy compared with undilated retinal examination. The potential risk of acute angle-closure glaucoma after pupil dilation has been hypothesized to be higher in Asian patients with diabetes mellitus.

Clinical case: A 61-year-old man with diabetes mellitus and hypertension was incidentally found to have elevated intraocular pressure (IOP) before routine retinal photography. He was asymptomatic and the visual acuity was 0.67 for both eyes. An ophthalmologist later found he had anatomical narrow-angle borderline glaucoma. Topical administration of pilocarpine and oral administration of acetazolamide were initiated, and laser iridotomy was later performed.

IOP screening: Among 1736 diabetic and/or hypertensive patients who underwent IOP screening, 31 patients (1.8%) had IOP of any eye persistently higher than 21 mm Hg on at least two occasions. The mean (standard deviation) IOP of the right eye was 24.1 (2.1) mm Hg, while that of the left eye was 24.6 (2.5) mm Hg. Four patients (12.9%) were found to have glaucoma, and treatment was initiated by an ophthalmologist. Therefore further study should be conducted to evaluate the cost-effectiveness of IOP screening among this group of patients.