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Effect of manual eyelid manipulation on intraocular pressure measurement by rebound tonometry
  1. Sung Uk Baek1,2,
  2. Ahnul Ha1,2,
  3. Young Kook Kim1,2,
  4. Jin Wook Jeoung1,2,
  5. Ki Ho Park1,2
  1. 1 Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
  2. 2 Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
  1. Correspondence to Dr Ki Ho Park, Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-744, Republic of Korea; kihopark{at}


Background/aims To investigate the effect of eyelid manipulation on the measurement of intraocular pressure (IOP) using two different tonometries (rebound tonometry (RT) vs Goldmann applanation tonometry (GAT)).

Methods 103 patients with primary open-angle glaucoma were prospectively enrolled. For all of the patients, IOP measurements were performed in three different ways: (1) RT with lid manipulation (LM), (2) RT without LM and (3) GAT. The order of the three measurements was randomly selected. Additionally, the palpebral fissure height (PFH; elliptical space between upper and lower eyelids) was measured.

Results The mean value of IOP measured by GAT was 13.97±2.80 mm Hg, which was not significantly different from that by RT without LM (13.75±2.44 mm Hg; P=0.096), but which was significantly lower than that by RT with LM (15.21±2.91 mm Hg; P<0.001). On a Bland-Altman plot, RT with LM was overestimated relative to GAT (mean: −1.5) and RT without LM (mean: −1.2). Among the high IOPs (>20 mm Hg), interestingly, those measured by RT without LM were significantly lower than those measured by GAT (P<0.001). In the subgroup analysis of PFH, the smaller the PFH, the more exaggerated the IOP difference between GAT (P=0.014) and RT with LM (P<0.001).

Conclusion RT-measured IOP was significantly exaggerated when manipulation was applied to the eyelid. This overall trend was more pronounced when PFH was small. GAT-measured IOP, meanwhile, showed a good correlation with IOP measured using RT without LM.

  • glaucoma
  • intraocular pressure
  • eye lids

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  • Contributors Study design: KHP, SUB, AH, YKK, JWJ. Writing the article: SUB. Data collection: SUB, AH, YKK, JWJ. Analysis and interpretation of the data: SUB, AH, YKK, JWJ, KHP. Literature search: SUB, AH, YKK, JWJ. Critical revision of the article: SUB, AH, YKK, KHP. Final approval of the article: KHP.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The authors alone are responsible for the content and writing of the paper.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board of Seoul National University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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