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  • Use of a speculum to measure IOP in newborns causes small IOP increase

    Glaucoma, Pediatric Ophth/Strabismus

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    Review of: The effect of an eyelid speculum on intraocular pressure measurement in newborns

    Çiçek A, Bayram N, Alabay B, et al. Journal of Pediatric Ophthalmology and Strabismus, January-February 2022

    This study compares intraocular pressure (IOP) measured with and without use of a Barraquer wire eyelid speculum in newborns.

    Study design

    In this nonrandomized prospective study conducted at a single center in Turkey, sequential IOP measurements were obtained from 54 eyes of 27 newborns. Topical anesthesia (proparacaine) was administered and the IOP was measured using the Icare PRO, first without a speculum and then again shortly thereafter using a speculum. Newborns with ocular or systemic disease and those unable to settle during the exam were excluded from the study.

    Outcomes

    Following placement of the speculum, the mean IOP was 2.65 mm Hg higher than prior to speculum placement. There was no correlation between IOP post-placement and either weight or postconceptual age at the time of examination. Therefore, the speculum itself seems to cause a significant though small increase in IOP.

    Limitations

    The number of patients excluded from the study were not reported. It would have been interesting to know the number of newborns who tolerated IOP measurement without a speculum but were excluded because they could not calm down for measurement with a speculum. Also, IOP without speculum placement was measured after administration of proparacaine, which is not necessary when using the Icare PRO.

    Clinical significance

    Intraocular pressure measured in newborns able to settle after eyelid speculum placement is likely reasonably accurate, and only slightly higher (2.65 mm Hg) than IOP measured without a speculum. Further studies are needed to clarify whether this is also true for patients with glaucoma.