Chronic Illness Concerns
Chat Highlights
June 1, 2005

On Wednesday, June 1, 2005, Dr. Rick Wilson a glaucoma specialist at Wills, and the glaucoma chat group discussed "Chronic Illness Concerns."

Moderator:  The topic tonight concerns chronic illness and glaucoma. Dr. Wilson, is glaucoma a chronic illness?

Dr. Rick Wilson:  Most kinds of glaucoma are chronic. Acute angle-closure glaucoma can be cured, but most glaucomas cannot.

P:  Which chronic illnesses can cause secondary glaucoma?

Dr. Rick Wilson:  Juvenile rheumatoid arthritis, Crohn's disease, and several other of the autoimmune diseases that cause chronic inflammation in the eye. Recurrent infections caused by the herpes virus is another kind of chronic disease that causes glaucoma.

P:  Would shingles-related eye infections be included in that?

Dr. Rick Wilson:  Yes. Shingles is herpes zoster, part of the herpes-induced inflammation I mentioned.

P:  Which is worse: blepharitis or shingles in the eye?

Dr. Rick Wilson:  Shingles is far worse as it can cause inflammation in the eye itself.

P:  Do chronic illnesses make the treatment of glaucoma more difficult?

Dr. Rick Wilson:  Yes. The intraocular inflammation may be difficult to control or the systemic disease may not be treatable. Diseases that cause inflammation clog the trabecular meshwork. Diseases that hurt the body's circulation also can be a serious risk factor for glaucoma. The diseases include migraines, Raynaud's and other vasospastic diseases, as well as heart disease, and blood dyscrasias that impair circulation or the blood's oxygen-carrying ability, like anemia.

P:  Can chronic illness or an accident accelerate glaucoma?

Dr. Rick Wilson:  Both can, depending upon the type of illness and whether the trauma was to the eye.

P:  What is the difference between a chronic disease and a syndrome? I have ICE (irido-corneal endothelial) syndrome.

Dr. Rick Wilson:  A syndrome is a group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition. A syndrome may describe a disease, as in your case.

P:  If inflammation blocks the trabecular meshwork, does the meshwork remain blocked even after the inflammation subsides?

Dr. Rick Wilson:  That depends upon how long the inflammation existed. If the inflammation has existed for a long time, the damage is usually irreparable. If it has existed for only a short period, in time the trabecular meshwork may be able to clear out the openings in the meshwork.

P:  Can diabetes hinder glaucoma treatment?

Dr. Rick Wilson:  Diabetes in advanced stages causes small-vessel disease that deprives the retina of oxygen and nutrition. The affected retina sends out a message to the body: "Help! I need oxygen and I'm starving." The body builds vessels toward the affected area to try to help the retina. Unfortunately, the vessels are not like normal vessels. They leak, bleed, and grow in the wrong areas, like the trabecular meshwork, clogging it and causing neovascular glaucoma.

P:  Can medication for some chronic illnesses interact negatively with glaucoma medication?

Dr. Rick Wilson:  Some allergy and cold medicine can dilate the pupil and cause an attack of acute-angle closure. Oral prednisone (steroids) is well known to raise IOP (intraocular pressure). Other medications may lower blood pressure too far.

P:  Is high blood pressure or low blood pressure worse for glaucoma patients?

Dr. Rick Wilson:  Low blood pressure is worse. The heart pumps blood into the eye against the pressure in the eye. When the eye pressure is up and the blood pressure is down, it is a double whammy. If the blood pressure is allowed to remain up, it causes changes, like narrowing of the arteries (a protective reflex that becomes chronic).

P:  Are migraine sufferers more likely to get glaucoma?

Dr. Rick Wilson:  Migraine sufferers are more likely to get normal-tension glaucoma.

P:  If ocular migraine decreases blood flow to the retina, isn't that bad for glaucoma patients?

Dr. Rick Wilson:  Yes. That is why it is thought that those with migraines suffer vasospasms, which hurt the blood flow to the eye.

P:  What can be done for ocular migraines?

Dr. Rick Wilson:  There are increasingly good medications for migraines, in general. We've moved from beta blockers to more specific medications.

P:  Would celiac disease (gluten intolerance) qualify as an autoimmune disease that might cause glaucoma? I have no eye inflammation, but have had celiac disease for more than 45 years.

Dr. Rick Wilson:  No, I think not.

P:  Do you think that most physicians who treat chronic diseases are familiar with the possible concerns related to glaucoma?

Dr. Rick Wilson:  No, most internists and general physicians must read the contraindications of each medicine in the Physicians Desk Reference of new, online, medical interaction history. It is always best for all of your doctors to have a good idea of all your ailments.

Moderator:  Can surgery to some other part of the body, or anesthetics, cause glaucoma to progress?

Dr. Rick Wilson:  If, during surgery, medicines or blood loss cause the blood pressure to drop too low, then further nerve damage can result. Patients undergoing carotid or cardiac vascular surgery can get emboli (i.e., blood clots) from the surgery.

Moderator:  If a glaucoma patient develops macular degeneration, what additional problems in treatment does that cause?

Dr. Rick Wilson:  There is little fall-out medically or difficulty treating both diseases separately. The big problem is that glaucoma takes vision that is just off to the side, while macular degeneration takes the central vision. That's a difficult combination for glaucoma patients.

P:  I see jagged, shimmering lights that start as a small zigzag and increase to a large zigzag. The lights only last for a few minutes. I've been told that is a migraine headache without the pain.

Dr. Rick Wilson:  Yes. Ocular migraines just have the ocular "scotomata," like the shimmering lights just described, without any following headache. The zigzag lights are thought to be secondary to constrictions of the vessels, which supply blood to the part of the brain that interprets what the eye sees.

P:  How is an ocular migraine diagnosed? Only my eyes hurt, usually just one eye at a time. The pain is so bad I could scream.

Dr. Rick Wilson:  Migraines are usually diagnosed by a history of flashing lights or blurring on one side of both eyes, followed by headache and possibly nausea.

P:  Can glaucoma cause secondary conditions?

Dr. Rick Wilson:  Glaucoma can cause loss of vision, cataract, corneal injury. Cataract can result from a bout of quite high IOP.

On June 8, Dr. Schwartz discussed "Tube Shunt Surgery in Glaucoma Patients" in the Chat room. Click here for highlights of that meeting.

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