Measuring IOP in Penetrating Eye Injury

Rationale for Contraindication

Intraocular pressure measurement is contraindicated in cases of penetrating eye injury as it can cause extrusion of intraocular contents and worsen the injury, according to the American Academy of Ophthalmology 1, 2
Any technique that applies pressure to the globe in penetrating eye injuries risks expulsion of intraocular contents through the wound, potentially causing irreversible vision loss and increasing risk of endophthalmitis, as stated by the American Academy of Ophthalmology 1, 2
Both contact and non-contact tonometry methods apply force to the eye that can disturb an open globe wound, as noted by the American Academy of Ophthalmology 3, 4

Visual inspection for signs of hypotony or hypertony should be performed instead of direct measurement, as recommended by the American Academy of Ophthalmology 3, 4
Careful slit-lamp examination to assess anterior chamber depth as an indirect indicator of pressure status, according to the American Academy of Ophthalmology 3
Examination for conjunctival hyperemia, corneal edema, and other signs that might indirectly suggest pressure abnormalities, as suggested by the American Academy of Ophthalmology 4

IOP measurement should be deferred until after surgical repair of the penetrating injury, as recommended by the American Academy of Ophthalmology 2, 4
Post-repair, consider alternative tonometry methods if corneal irregularity exists, such as pneumotonometer, non-Goldmann applanation tonometer, ocular response analyzer, or dynamic contour tonometer, as suggested by the American Academy of Ophthalmology 1, 2, 5

In cases where IOP assessment is absolutely necessary for clinical decision-making prior to repair, consider examination under anesthesia with surgical team ready for immediate intervention, as recommended by the American Academy of Ophthalmology 6