The effect of different eyelid speculums compared to manual eyelid opening on intraocular pressure in children under general anesthesia

Purpose: To evaluate the effect of 4 commonly used eyelid speculums on intraocular pressure (IOP) among children undergoing examination under anesthesia. Methods: In this comparative cross-sectional study, IOP of children undergoing EUA at Soroka Medical Center was measured by manually opening the eyelids and the result was compared to measurements taken with 4 commonly-used speculums. Barraquer and Alfonso speculums were used in patients of all ages, whereas V- and U-shaped speculums were used in patients older than 6 months of age only. All measurements were taken using a Tono-Pen tonometer. Results: Data were collected from 41 eyes of 21 patients (8 eyes ≤ 6 months of age). Mean age was 3.6 years (range 10 days-14 years), and 52% were male. Mean IOP without an eyelid speculum was 14.3 ± 4.7 mmHg. In comparison to manual eyelid opening, the mean IOP measurement with the Barraquer speculum did not differ significantly (14.7 vs. 14.3 mmHg, respectively, p = 0.139). However, all other types of speculums significantly increased IOP measurements (14.3 vs. 18.9 mmHg, p < 0.001) for Alfonso speculum, (15.0 vs. 19.0 mmHg, p < 0.001) for V-shape speculum, and (15.0 vs. 18.8 mmHg, p < 0.001) for the U-shape speculum. The results were the same when the data from each eye were analyzed separately. Conclusions: The Barraquer speculum did not affect IOP measurements under general anesthesia among children up to age 14 years. IOP measurements obtained with other types of speculums are expected to be overestimated. Key messages: What is known : • Obtaining accurate IOP measurements in children with glaucoma is important to assess disease progression and guide treatment decisions. What is new : • The Barraquer speculum did not affect IOP measurements under general anesthesia among children up to 14 years. • IOP measurements obtained with other types of speculums are usually overestimated.