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The diurnal curve in man: new observations.

During our preliminary studies correlating frequent ocular tension measurements with other physiologic and biochemical parameters in man, we noted that intraocular tension was lowest in the early morning, generally around 3 A.M., in all subjects. This observation is at variance with most published data reporting lowest values during the afternoon. Short-term fluctuations in ocular tension were also observed in this study. Eleven subjects, five normal subjects and six subjects with various types of glaucoma (juvenile glaucoma, steroid-induced glaucoma, unilateral traumatic glaucoma, pigmentary glaucoma, and chronic simple glaucoma) were examined. Each subject was placed at bed rest for a minimum of 24 hours during which time studies were conducted. Glaucoma subjects had their medications discontinued at least 24 hours prior to the start of the testing. Ocular tension was measured hourly or more frequently (every 20 minutes for several hours) using a calibrated MacKay-Marg electronic tonometer. All subjects were able to tolerate this repeated tonometry either with no anesthetic agent or with dilute (1:10 in sterile water) Ophthaine. No corneal damage was noted during or subsequent to the testing. The average of five good traces was recorded as the ocular tension. Other parameters measured in some but not all subjects included plasma samples taken every 20 minutes by venous catheter for assay of endogenous cortisol and growth hormone, and hourly blood pressure, pulse rate, rectal temperature, as well as polygraph recordings of electroencephalogram, EOG, and chin electromyogram done during nocturnal sleep hours (11 P.M. to 7 A.M.). The lowest ocular tension was recorded in all eleven subjects during the early morning hours (2 to 4 A.M.). All six glaucoma subjects had a tension below 20 mm. Hg at this time regardless of the level of their ocular tension during the day. Unexpected was the finding of short-term fluctuations in ocular tension noted in both normal and glaucomatous eyes. Differences of from 5 to 9 mm. Hg were noted in one hour, and 3 to 4 mm. fluctuations were found over 20 minute sampling periods. In all instances both eyes showed fluctuations of intraocular tension in a similar direction at the same time. Fig. 1 is the diurnal record of a 42-year-old white male with unilateral glaucoma secondary to traumatic angle recession. His ocular tension has been difficult to control with any combination of medical therapy. His record shows that without therapy he attains a normal ocular tension in his diseased left eye early in the morning. His normal right eye also has its lowest ocular tension during the same hours. Fig. 2 is a composite of the diurnal traces of all eleven subjects; all had their lowest ocular