TONOMETER

The intraocular pressure (IOP) is

measured with the help of an
instrument called tonometer.
Two basic
types of
tonometers
available are 1) INDENTATION 2) APPLANATION
 Indentation (impression) tonometry is based on
the fundamental fact that a plunger will indent a
soft eye more than a hard eye.

The indentation tonometer in current use is that of

INDENTATION sciotz, who devised it in 1905 and continued to
TONOMETER refine it through 1927.

Because of its simplicity, reliability, low price and

relative accuracy , it is the most widely used
tonometer in the world.
 It consists of

Handle for holding the instrument in vertical position on the cornea

Foot plate which rests on the cornea

SCHIOTZ Plunger which moves freely within a shaft in the footplate

TONOMETER
Bent lever whose short arm rests on the upper end of the plunger and a
long arm which acts as a pointer needle

The degree to which the plunger indents the cornea is indicated by the
movement of this needle on a scale and

Weighs : a 5.5gm weight is permanently fixed to the plunger, which

can be increased to 7.5 and 10gm
 Before tonometry, the footplate and a
lower end of plunger should be sterilized
TECHNIQUE
OF SCIOTZ
TONOMETRY For repeated use in multiple patients it
can be sterilized by dipping the footplate
in ether, absolute alcohol, acetone or by
heating the footplate in the flame of spirit.
After anaesthetising the cornea with paracaine or 2-4 percent
topical xylocaine, patient is made to lie supine on a couch and
instructed to fix at a target on the ceiling.

Then the examiner separates the lids with left hand and gently
rests the footplate of the tonometer vertically on the centre of
cornea .

The reading on scale is recorded as soon as the needle becomes

steady.
It is customary to start with 5.5gm weight

However, if the scale reading is less than 3, additional weight should be added to the plunger to
make it 7.5gm or 10gm, as indicated; since with schiotz tonometer the greatest accuracy is
attained if the deflection of lever is between 3 and 4.

In the end, tonometer is lifted and a drop of antibiotic is instilled.

A conversion table is then used to derive the intraocular pressure in mm of mercury (mmHg)
from the scale reading and the plunger weight.
The main advantages of sciotz tonometer are that it is cheap, handy and
easy to use.

Its main disadvantage is that it gives a false reading when used in eyes
with abnormal scleral rigidity.

False low levels of IOP are obtained in eyes with low scleral rigidity as
seen in high myopes and following ocular surgery.
 The concept of applanation tonometry was introduced
by Goldmann in 1954.

It is based on Imbert-Fick law which states that the

APPLANATION pressure inside a sphere(p) is equal to the force(w)
TONOMETRY required to flatten it’s sphere divided by the area of
flattening(A); i.e , P=W/A

The commonly used Applanation tonometers are :

 Currently, it is the most popular and
accurate tonometer.

GOLDMANN It consists of a double prism mounted

TONOMETER: on a standard slit-lamp.

The prism applanates the cornea in an

area of 3.06mm diameter.
 After anaesthetising the cornea with a drop of 2% xylocaine and staining the tear film
with fluorescein patient is made to sit in front of slit-lamp.

The cornea and bioprisms are illuminated with cobalt blue light from the slit-lamp.

Bioprism is then advanced until it just touches the apex of cornea.

TECHNIQUE At this point two fluorescent semicircles are viewed through the prism.

Then, the applanation force against cornea is adjusted until the inner edges of the two
semicircles just touch.

This is the end point.

The intraocular pressure is determined by multiplying the dial reading with ten.
 This is a hand-held tonometer utilizing
the same biprism as in the Goldmann
applanation tonometer

PERKINS It is small, easy to carry and does not

APPLANATION require slit-lamp .
TONOMETER

However, it requires considerable

practice before, reliable readings can be
obtained.
 In this, the cornea is applanated by touching it’s apex
by a silastic diaphragm covering the sensing nozzle
(which is connected to a central chamber containing
pressurised air).

PNEUMATIC
TONOMETER
In this tonometer, there is a pneumatic-to-electronic
transducer, which converts the air pressure to a
recording on a paperstrip, from where IOP is read
PULSE AIR
TONOMETER
• It is a hand-held, non contact tonometer that can be used with
the patient in any position.
 It is a computerised pocket
tonometer .

TONO-PEN
It employes a microscopic transducer
which applanates the cornea and
converts IOP into electric waves.
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