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Low-Tension Glaucoma: An Oxymoron in Ophthalmology

Flowchart. Top box “Glaucomatous optic neuropathy” leads to 2 paths. On left side, it leads to Nyctohemeral IOP (with CCT determination) curve within normal range, which then leads to Non-IOP–related optic neuropathy and then to Assessment of the ocular and optic nerve perfusion pressure. At this point, the path diverges. On the left, to Normal perfusion pressure, Examination for neurological diseases, and neurologist. On the right side, Low perfusion pressure, Optic nerve ischemic disease, Examination for cardiovascular diseases, and Cardiologist. The second of 2 paths from Glaucomatous optic neuropathy leads to IOP (with CCT determination) within normal range. This path diverges into Diurnal IOP fluctuation or Nocturnal IOP acrophase. The 2 paths reunite at POAG, which then leads to Diagnostic and therapeutic strategies as for hyperbaric glaucomas and Ophthalmologist.

Proposed flowchart of optic neuropathy, with specialist referral, according to the nychthemeral IOP characteristics. Abbreviations: CCT, central corneal thickness; IOP, intraocular pressure; POAG, primary open-angle glaucoma.

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