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To the Editor.
—Although the Goldmann applanation tonometer is a highly accurate instrument, artifacts in measurement of intraocular pressure may occasionally mislead the examiner. Spurious elevations of intraocular pressure may occur on the basis of such patient-related factors as excessive widening of lid fissures,1 blepharospasm, blinking, and tilting of the patient's head.2 Inadvertent pressure exerted on the globe by the examiner while elevating a patient's lid may also cause errors.Occasionally, external factors interfering with the tonometer itself may affect the measurement. Pressure against the arm of a superiorly mounted Goldmann applanation tonometer by an "Afro" hairdo has been reported previously in the Archives.3 We report an analogous situation in which a patient's moustache interfered with the forward movement of the arm of a base-mounted Goldmann applanation tonometer. The patient was a 41-year-old man referred for consultation regarding his pigmentary glaucoma. The initial intraocular pressure reading
Ritch R, Reyes A. 'Moustache Glaucoma'. Arch Ophthalmol. 1988;106(11):1503. doi:10.1001/archopht.1988.01060140671008