Check iop with fingers
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8 weeks ago
Olesya • 10
@_373

Hi! I try to find out what IOP i have using my fingers. Results are different. Sometimes it seems me that my eyeballs are harder than usually. If i do massage of my neck and my face eyeballs become soft.. If i bend my head on the right or on the left and then check IOP by fingers in this position my eyeballs are really softer too... Anybody has the same experience?

glaucoma • 123 views
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8 weeks ago
david 3.9k
@david_fe

Thank you for your question. You are probably detecting a valid pattern. It is possible that massaging your neck may reduce your IOP. This helps many people. Relaxing the muscles in your face can be helpful too.

However, touching your eyelid with your finger is not a reliable method for monitoring your intraocular pressure ("IOP"). You need a real tonometer to find out if the neck massages or anything else are actually reducing your IOP. You could be guessing wrong, as I was, when using the finger method.

On the email discussion list, a person stated the following:

For some reason, I have developed the ability to "guess" my iop simply by gently touching my lid with my index finger and assessing iop by relative hardness/softness.

Here is my reply, which remains the same now as it was when I replied to the above statement:

This person has most likely been on a lucky streak. If any of you think you can do this technique accurately, I suggest you do a real test with sufficient data -- test it one hundred times and write down every result. You will almost certainly find out that you cannot in fact accurately and reliably determine your IOP to within 1 or 2 mmHg using this method over a large number of measurements.

My method: I have tested this hundreds and hundreds of times. Here is the method I used. I would sit in front of my Reichert tonometer and touch my eyelid with my finger to feel the relative hardness/softness of my eye and use that to guess my actual IOP. Then I would immediately check my IOP with my tonometer. I would note any difference and try to improve my skills. As I said, I practiced this hundreds and hundreds of times. Initially, I thought I was learning and getting better at it.

My results: I ultimately found that while I could sometimes guess reasonably well, I was fooled badly at times. In fact, not only could I be off by a larger amount in my estimate of my IOP, I often found that when I thought my IOP had gone up by the finger technique, the tonometer showed that it had actually gone down, and vice versa. In other words, my eyes would feel softer, but my IOP would actually be higher. Or my eyes would feel harder, but my IOP would actually be lower. Again, these bad guesses did not happen every time, but they happened enough to make this finger method unsuitable.

Conclusion: The possibility of large errors, and being completely wrong about the direction of the IOP change (e.g., up vs. down), led me to conclude that this finger technique (called "digital palpation of intraocular pressure") could be disastrous if I relied on it for my personal IOP research.

Additional Background: See What Are Examples of the Different Approaches to Home Eye Pressure Monitoring?. I have always been interested in accurate IOP results from my home monitoring efforts. There may be circumstances, although I cannot actually think of any which are valid, where accuracy is not important. If accuracy is not important, maybe you can use "digital palpation of intraocular pressure." But, if accuracy is not important, why bother? Why spend a minute or two touching your finger to your eye and guessing your IOP when the information you obtain is not reliable? Also, who is going to take you seriously? Will your doctor take anything you say about your IOP seriously if you are measuring it with your finger? We can barely get most ophthalmologists to take our home IOP data seriously when we are using research-quality tonometers such as the Reichert 7CR.

There are published papers on this topic. Search PubMed for "digital palpation of intraocular pressure." It's an old, well-known method.

A few papers claim that doctors can learn to do it, but the overall evidence is that digital palpation of intraocular pressure is not sufficiently accurate or reliable. Again, my own testing shows that while you can get good enough to be within a few points of correct many times, there will be multiple situations when you are entirely, badly wrong. That could be very dangerous. I think you are better off not even trying this so as to avoid those times when you would fool yourself badly.

Other answers are welcome, of course. That's the purpose of Ask FitEyes. All members can provide answers and/or vote on the most helpful answers.

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8 weeks ago
EyeTidbits • 70
@eyetidbits

Dave provided an excellent response. However, as feedback, I am also one to feel my eyeballs through closed lids as a non-quantitative method of eye-pressure awareness. They are softer & sometimes feel smaller (probably less vitreous fluid which might correlate with lower pressure) when I am relaxed, after aerobic exercise, or a few hours after instilling glaucoma medication. They feel harder especially under periods of stress or higher sodium diet, or if I’ve forgotten to apply medication drops. Sometimes, if they feel extra hard or bulgy, I use an extra medication temporarily in addition to my routine medication. But, Dave is correct - monitoring qualitatively with measurements from a tonometer would be most reliable. Nice to know I’m not the only one who does this manual palpation, though & that there were studies out there!

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