The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Ocular hypertension (OHT) is consistently high intraocular pressure (IOP) in the absence of optical nerve damage, visual field defect or any other pathology that could explain it. Population prevalence estimates range from 4.5% to 9.4% in those aged over 40. One in 10 of patients in whom the condition is left untreated develop primary open angle glaucoma (POAG) within 5 years. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and treating OHT. It provides recommendations for non-pharmacological management approaches and treatment options, and for when referral may be appropriate.
What is ocular hypertension?
Ocular hypertension (OHT) means you have consistently higher-than-normal pressure inside your eye, but no signs of glaucoma. This condition does not cause symptoms and is not glaucoma, as there is no damage to the optic nerve (the nerve of sight). Without treatment, around 1 in 10 people with OHT will develop primary open angle glaucoma (POAG) within five years.
How is ocular hypertension managed?
If your optometrist thinks you have a moderate or high risk of developing glaucoma, they may refer you to an ophthalmologist (specialist eye doctor) or a specialist optometrist for further assessment. The case can then be re-assessed and, if necessary, treatment with a laser procedure called selective laser trabeculoplasty (SLT) or pressure-lowering eyedrops. Both treatments help lower the pressure inside the eye by reducing the amount of fluid produced or improving how well it drains away.
Ocular hypertension (OHT) - 10 September 2026 The aetiology section has been updated to include updated data from longitudinal studies on the risk of progression from ocular hypertension (OHT) to glaucoma and severe visual field loss. Additional risk factors associated with the development of OHT have been incorporated into the predisposing factors section. The signs section provides additional clarity on anterior chamber angle assessment using different examination techniques. The non-pharmacological management section has been revised to reflect national recommendations in OHT referral, monitoring, treatment and pathway design. The management category section sets out the recommended referral pathways for suspected and confirmed OHT. In the possible management section, additional detail has been provided on the range of interventions available according to the risk of visual impairment.
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