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Comparative Study
. 2025 Aug;263(8):2315-2323.
doi: 10.1007/s00417-025-06808-7. Epub 2025 Mar 29.

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

Oren Iny #  1   2   3 , Achia Nemet #  4 , Erez Tsumi  5   6 , Asim Ali  7   8 , Chiya Robert Barrett  5   6   4 , Ahed Imtirat  5   6
Affiliations
Comparative Study

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

Oren Iny et al. Graefes Arch Clin Exp Ophthalmol. 2025 Aug.

Abstract

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.

Keywords: Examination under anesthesia (EUA); Intraocular pressure (IOP); Pediatric intraocular pressure; Speculum.

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Conflict of interest statement

Declarations. Ethical approval: This study was approved by the Institutional Review Board of Soroka University Medical Center and was conducted in accordance with the tenets set forth in the Declaration of Helsinki. Signed informed consent from both parents was obtained for all participants. Conflict of interest: No conflicting relationship exists for any author. Proprietary interest: The authors have no proprietary interest in any aspect of the study.

References

    1. Heijl A, Leske MC, Bengtsson B et al (2002) Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol. https://doi.org/10.1001/archopht.120.10.1268 - DOI - PubMed
    1. Coleman DJ, Trokel S (1969) Direct-recorded intraocular pressure variations in a human subject. Arch Ophthalmol. https://doi.org/10.1001/archopht.1969.00990020633011 - DOI - PubMed
    1. Frantz KA, Peters RJ, Maino DM, Gunderson GG (1994) Effect of resisting tonometry on intraocular pressure. J Am Optom Assoc 65(10):732–6 - PubMed
    1. Gandhi PD, Gürses-Özden R, Liebmann JM, Ritch R (2001) Attempted eyelid closure affects intraocular pressure measurement. Am J Ophthalmol. https://doi.org/10.1016/S0002-9394(00)00802-3 - DOI - PubMed
    1. Cicek A, Bayram N, Alabay B, Vural E (2022) The effect of an eyelid speculum on intraocular pressure measurement in newborns. J Pediatr Ophthalmol Strabismus. https://doi.org/10.3928/01913913-20210518-01 - DOI - PubMed

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