Here’s a tono-tip that I picked up from Dr. Robert DiMartino, one of the clinical professors at UC Berkeley, School of Optometry. You know the target that sits on the arm that swivels from the top of the slit lamp forehead-rest? It’s there for a reason. A lot of my colleagues (myself included) had neglected to use that target to direct patient gaze.
As it turns out, placing this target in front of the contralateral eye makes measuring IOP with Goldmann tonometry considerably easier for a lot of patients. Just set it up so that the eye of interest is pointing in the right direction. Don’t forget that a lot of these targets have a lever or knob that allows you to alter the focus of the target for the patient, based on their refractive error. Ask them if it’s clear, and direct their attention toward the target, while telling them to ignore the blue light.
I’ve had a number of patients tell me that they found this to be a lot easier than when people have tried to measure their IOP in the past. Use of the target, of course, is not restricted to tonometry. Use it as often as you need to for other procedures on patients with eyes that like to wander.