Chat Highlights
Inflammation and Glaucoma
September 5, 2001

Norma Devine, Editor

On Wednesday, September 5, 2001, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Inflammation and Glaucoma." 

Moderator:  Welcome, Dr. Wilson.  The topic tonight is "Inflammation and Glaucoma."

Dr. Rick Wilson:  Thanks.  First question?

P:  How does inflammation affect the eye?

Dr. Rick Wilson:  Inflammation has several deleterious effects on the outflow.  It makes the fluid in the eye thicker, as well as the beams in the drain, so the spaces between them are smaller.  And the white cells in the fluid can block the trabecular meshwork.

P:  What does it mean when a glaucoma specialist says I have some inflammation?

Dr. Rick Wilson:  You could have inflammation of the conjunctiva (the clear layer over the sclera), as in an allergy or Xalatan toxicity; of the sclera , as could be seen with rheumatoid arthritis; in the anterior chamber (iritis); or the whole middle layer of the eye (uveitis).

P:  What causes inflammation?

Dr. Rick Wilson:  Any of the prostaglandins can cause extra- or intraocular inflammation.  Trauma causes inflammation, as does infection.  About 50% of uveitis does not have a cause that we can determine. 

P:  How is the diagnosis of intraocular inflammation made?

Dr. Rick Wilson:  The thickening of the fluid in the eye, as well as the white cells in the anterior chamber, can be seen using the slit lamp microscope.  It's really a wonderful invention, and ophthalmologists are fortunate to be able to see almost the entire organ, as opposed to what most other kinds of specialists can see of an organ. 

P:  Inflammation is seen in what conditions?  

Dr. Rick Wilson:  Inflammation is mostly seen in inflammatory glaucoma, traumatic or neovascular glaucoma, or related to lens breakdown products.

P:  How does a doctor determine the presence of inflammation from sarcoidosis?

Dr. Rick Wilson:  By seeing if the fluid in the front of the eye is turbid and contains white cells.  

P:  Can white cells be seen in the posterior chamber?

Dr. Rick Wilson:  Yes.

P:  How is inflammation treated?

Dr. Rick Wilson:  Since steroids, used either topically or orally, can cause the IOP (intraocular pressure) to increase if used for any length of time, we try short-term steroids and hope to move to non-steroidals, such as Voltaren or Acular. If we use steroids over the long haul, we might use a steroid like Lotemax or Vexol, which  are supposed to cause less of an increase in pressure.

P:  How long would you consider too long to use topical steroids? 

Dr. Rick Wilson:  Some patients get steroid glaucoma after six weeks; others in as few as two weeks.  The percentage of  responders to steroids goes up with months of use.

P:  Is inflammation common after a trabeculectomy?  

Dr. Rick Wilson:  Inflammation is natural after any surgery, especially in eyes that have been on several medications before surgery or have had a laser.  Alphagan, Propine, Iopidine,  pilocarpine, and the prostaglandins seem to be the worst offenders.

P:  Using Pred Forte for four to six months would not increase the pressure in the eye, would it? 

Dr. Rick Wilson:  It easily could.  Pred Forte is one of our stronger steroids.

P:  What medication is best for long-term control of inflammation?  

Dr. Rick Wilson:  For non-steroid responders, prednisolone 1%.

P:  How can the doctor determine that there is inflammation of the choroid/macula?

Dr. Rick Wilson:  The macula usually is inflamed only by infection, whereas the choroid is often inflamed.  An intravenous injection of fluorescein is followed by pictures as the fluorescein goes through the vessels and gives indications of the location of the inflammation.  

P:  Could allergies make inflammation worse?

Dr. Rick Wilson:  Not really, unless you are prone to trauma.

P:  Allergies make my eyes red and swollen.  Could that also cause a rise in IOP?  It seems to. 

Dr. Rick Wilson:  Allergies usually don't cause an increase in IOP. Perhaps if the vessels are inflamed, medication used to treat the elevated pressure may be carried away faster than usual, causing a secondary rise in IOP.

P:  Does the histamine released with allergies affect IOP?  

Dr. Rick Wilson:  I haven't seen or read about any such effect on IOP. 

P:  Is inflammation painful?

Dr. Rick Wilson:  Inflammation can be painful with eye ache, light sensitivity, and blurred vision.

P:  Is the inflammation visible?  My eyes often look red and inflamed.

Dr. Rick Wilson:  The inflammation is often visible as a red eye.

P:  What medication is best for long-term control of inflammation?  

Dr. Rick Wilson:  For non-steroid responders, prednisolone 1%.

P:  Are there any other drugs, such as cycloplegics, that are useful to quell inflammation? 

Dr. Rick Wilson:  Cycloplegics relax the muscle in the eye and make the eye much more comfortable.

P:  I have eye ache, light sensitivity and blurred vision most of the time.  I have learned to accept it as normal for me, but should it be treated?

Dr. Rick Wilson:  That would depend upon the cause.  Your eye doctor should be able to tell you.

P:  Why is a bleb sometimes puffed up and sometimes flat? 

Dr. Rick Wilson:  Blebs often get elevated as the body scars down the conjunctiva around the area where the fluid is coming through the wall of the eye.  The pressure of the fluid is concentrated in that area and inflates the conjunctiva.

End of highlights for September 5, 2001.

On September 12, Dr. Wilson discussed "How to Handle a Failing Trabeculectomy" in the Chat room. Click here for highlights of that meeting.

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