Ocular Hypertension: What It Is and Why It Matters

High eye pressure (intraocular pressure or IOP) can be sneaky. With ocular hypertension you have higher-than-normal IOP but no clear damage to the optic nerve and no visual field loss yet. That sounds reassuring, but elevated pressure raises the chance of developing glaucoma later, so it deserves attention.

Think of ocular hypertension as a warning sign. Not everyone with high IOP will get glaucoma, but some will. The goal is to find who’s at higher risk and act early enough to protect vision.

How doctors check for risk

Eye exams for ocular hypertension focus on measuring pressure and checking the optic nerve. Common tests include:

• Tonometry – measures IOP (air puff or contact methods).
• Pachymetry – measures corneal thickness; a thin cornea can hide higher true pressure.
• Optic nerve exam – the doctor looks for cupping or other signs of damage.
• Visual field test – checks for early blind spots you wouldn’t notice yet.
• OCT (optical coherence tomography) – images the nerve fiber layer for subtle thinning.

When treatment makes sense

Not every case needs medicine. Treatment depends on risk factors: how high the pressure is, corneal thickness, optic nerve appearance, age, and family history. Big trials, like the Ocular Hypertension Treatment Study (OHTS), found that treating people at higher risk can cut the chance of developing glaucoma by roughly half. So if you’re high-risk, starting eye drops or having laser treatment is often worth it.

Typical treatments:

• Eye drops – prostaglandin analogs, beta-blockers, alpha-agonists, or carbonic anhydrase inhibitors to lower IOP.
• Laser trabeculoplasty – a clinic procedure that helps fluid drain from the eye.
• Surgery – reserved for cases where drops and laser don’t reach target pressure.

Side effects vary by drug, so talk with your eye doctor about what fits your health and lifestyle.

Simple things you can do

Stick to appointments and medication. Small habits help too: choose regular moderate exercise, avoid long-term steroid eye or systemic use unless prescribed, manage blood pressure, and sleep with your head slightly raised if a doctor recommends it. If you notice vision changes, flashes, or sudden pain, contact your eye doctor right away.

If you have a family history of glaucoma, are over 60, of African or Hispanic descent, or have had eye injuries or steroid treatment, mention that at your visit—these raise risk and may mean closer monitoring.

Ocular hypertension isn’t an emergency for most people, but it’s not something to ignore. With the right testing and follow-up, you can protect your sight and keep pressure under control.