Mathematical Discrepancies of the Tono-Pen Applanation Tonometer.

PURPOSE OF THE STUDY: The purpose of the study was to determine if Tono-Pen tonometers use simple average and coefficient of variation (CV) algorithms to calculate intraocular pressure (IOP). MATERIAL AND METHODS: IOPs were measured as part of routine ocular examination in 152 client-owned dogs. Using 11 Tono-Pen's, a total of 778 averaged readings were collected. Individual IOP readings, and average IOP and CV displayed by the instrument, were recorded. Average IOP and CV were then manually calculated from individual readings and compared with those displayed by the instrument. RESULTS: The mean absolute difference between the calculated and displayed average IOP was 1.37±2.01 mm Hg (P<0.001). In 6% of cases, the calculated average IOP was 5 to 15 mm Hg different from the displayed average IOP. The difference between the displayed and calculated average IOP was significantly higher in hypertensive eyes with displayed IOP≥25 mm Hg. Calculated CV was equal to, lower than, or greater than displayed CV in 28.6%, 1.5%, and 69.7% of cases, respectively. In 17.6% of cases, calculated CV was >20%, but displayed CV was <5%. Receiver operating characteristic analysis could not correlate number of individual IOP readings with magnitude of difference in average IOP. CONCLUSIONS: Calculated average IOP and CV differ significantly from values displayed by the instrument, especially at higher IOPs. A difference of ≥5 mm Hg between calculated and displayed average IOP seen in 6% of cases may impact clinical judgement. Displayed CV<5% does not correlate with accurate IOP measurement based on individual results.

Effects of intramuscular injection of glycopyrrolate on Schirmer tear test I results in dogs.

OBJECTIVE To determine effects of glycopyrrolate administered IM on Schirmer tear test I (STT I) measurements in dogs. DESIGN Prospective clinical study. ANIMALS 13 client- and staff-owned dogs. PROCEDURES For both eyes of each dog, STT I measurements were recorded twice 20 minutes apart (at T1 and T2) and 2 to 4 hours later (at T3). Glycopyrrolate (0.01 mg/kg [0.005 mg/lb]) was administered IM to all dogs (3 dogs received an injection of saline [0.9% NaCl] solution on an earlier occasion), and final STT I measurements were recorded 20 minutes later (at T4). Intraocular pressures, heart rate, and respiratory rate were also recorded at each time point. RESULTS Ophthalmic variables did not differ between right and left eyes. In all dogs, variables at T1, T2, or T3 (measurements before glycopyrrolate administration) did not differ; baseline values were therefore defined at T3. At T4, STT I measurements were significantly decreased (mean ± SD decrease, 67.4 ± 15.4% [mean actual decrease, 15.8 mm/min]). During the same period, mean heart rate increased by 26.5 ± 12.0% (mean actual increase, 30.2 beats/min). Glycopyrrolate had no effect on intraocular pressure or respiratory rate. In 5 dogs at 24 hours after glycopyrrolate treatment, STT I measurement in each eye had returned to baseline value. Saline solution treatment (3 dogs) had no effect on any variables. CONCLUSIONS AND CLINICAL RELEVANCE In dogs, IM injection of glycopyrrolate resulted in a clinically relevant transient decrease in aqueous tear production. Application of lacrimomimetics beginning at the time of or within 20 minutes after glycopyrrolate premedication is recommended until STT I measurements return to baseline.

Effects of anesthetic induction with midazolam-propofol and midazolam-etomidate on selected ocular and cardiorespiratory variables in clinically normal dogs.

OBJECTIVE: To compare effects of anesthetic induction with midazolam-propofol or midazolam-etomidate on intraocular pressure (IOP), pupillary diameter (PD), pulse rate, blood pressure, and respiratory rate in clinically normal dogs. ANIMALS: 18 dogs. PROCEDURES: Dogs undergoing ophthalmic surgery received midazolam (0.2 mg/kg, IV) and either propofol or etomidate (IV) until intubatable. For all dogs, results of physical examinations, ophthalmic examinations of the nonoperated eye, and preanesthetic blood analyses were normal. Intraocular pressure, PD, blood pressure, pulse rate, and respiratory rate were measured in the nonoperated eye at 5 time points: just prior to the anesthetic induction sequence, after 5 minutes of preanesthetic oxygenation via face mask, after IV administration of midazolam, after IV anesthetic induction, and after endotracheal intubation. RESULTS: PD decreased significantly from baseline by 4.4 ± 0.4 mm (mean ± SD) after anesthetic induction and 5.3 ± 0.4 mm after intubation in the etomidate group and by 1. 2 ± 0.4 mm after intubation in the propofol group. Intraocular pressure was increased significantly from baseline by 3.2 ± 1.0 mm Hg after anesthetic induction in the etomidate group and by 4.7 ± 1.2 mm Hg after anesthetic induction and 4.5 ± 1. 2 mm Hg after intubation in the propofol group. Pulse rate was significantly lower by 28.6 ± 12.6 beats/min after anesthetic induction in the etomidate group, compared with the propofol group. CONCLUSIONS AND CLINICAL RELEVANCE: At the studied doses, midazolam-etomidate caused clinically important miosis and increased IOP. Midazolam-propofol caused an even greater increase in IOP but had minimal effects on PD.