Pressure Behind Eyes

This is one of our pretty common complaints, and a confusing symptom for both patients and referring MD's. When a patient presents to them with a complaint of "pressure behind eyes", they often immediately make the leap to "glaucoma" because glaucoma is usually associated with high intraocular pressure. Turns out a complaint of "pressure" in or around or behind the eyes is almost never glaucoma. The most common and likely cause of a feeling of pressure is SINUS INFECTION, or at least sinus pressure, not high intraocular pressure. It ends up being a little bit humorous that the MD refers them to us to "check their eye pressure" and we usually end up sending them right back to the referring primary care provider to manage sinus pressure. Intraocular pressure is measured in "milimeters of mercury" (mmHg). It's a pressure reading like PSI for your tires, but obviously much lower. The worldwide average normal intraocular pressure is about 16mmHg. Most eye care providers agree that a pressure over about 22 (along with many other factors, by the way) is usually considered "suspect" for glaucoma. A pressure over 30 is almost always glaucoma. Almost no patient can feel a pressure under about 40. That's why glaucoma is called "the silent sight stealer" - it's generally symptomless until it's too late and you've already lost vision. And when a patient does feel a high pressure, it does not feel like pressure! It feels like PAIN. Patients with high eye pressure between 22-40 feel NOTHING, not even pressure...and patients with high eye pressure over 40 don't feel "pressure" either! They feel PAIN (and redness, and blur). So basically almost no one who says the words "I feel like there's pressure in/on/around/behind my eyes" has that symptom from undiagnosed glaucoma. It's just that the MD's pick up on the keyword "pressure" and leap to "eye pressure" (intraocular pressure) and start thinking glaucoma, or the patients Google "eye pressure" and come up with glaucoma. I, of course, am not saying that it's impossible for a patient with a complaint of "eye pressure" to have glaucoma. I'm sure some of them do, because glaucoma is generally symptomless! I'm just saying that when someone says the catchphrase "pressure behind eyes", I am making the leap to probable SINUS PRESSURE, not intraocular pressure.