Abstract
The office management of a disease such as glaucoma offers a formidable challenge. Therapeutic nimbleness must be based upon sound knowledge and continued perusal of the literature. The phasic variation in ocular tension and the facility of aqueous outflow should be determined, and all glaucomatous eyes should be periodically subjected to perimetric study, ophthalmoscopic and slit lamp examination, refraction, gonioscopy, and measurement of the intraocular pressure. Phasic Variations in Ocular Tension A rhythmic diurnal variation in ocular tension is characteristic of the individual and occurs in a definite pattern which is the same in both eyes. It is independent of sleeping and eating habits, rest, work, blood pressure, age, sex, refractive error, and width of chamber angle. This oscillation in tension is made up of a descending and an ascending phase. A diurnal fluctuation of 5.0 mm. Hg Schiotz is rarely exceeded in the eye of a normal person. In
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