Inflammation and Glaucoma
Chat Highlights
September 2, 2009

On Wednesday, September 2, 2009, Dr. Michael Pro, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Inflammation and Glaucoma".

Moderator: Our topic this evening is Inflammation and Glaucoma. What is inflammation?

Dr. Pro: Inflammation means that the body has mounted an immune response. In the eye it's called uveitis. Specifically, in the front of the eye we may refer to it as iritis, and in the back of the eye, vitritis, or other terms.

The eye can be inflamed for various reasons. An infection can cause inflammation in the eye, surgery can cause an inflammation in the eye, and sometimes the inflammation is present for no reason that we can find.

P: What are the most common causes of inflammation?

Dr. Pro: The most common reasons are infections and post-surgical inflammation. Generally in these cases the inflammation is limited to either the duration of the infection, or for a short time after the surgery.

P: Does inflammation differ in the eye compared to other parts of the body?

Dr. Pro: Well, inflammation can cause problems in other parts of the body that can be quite severe. But unique to the eye is the fact that the doctor can actually see white blood cells floating around within the eye. Thus you can titrate your treatment based on this finding. In other parts of the body the treatment can be based on more indirect measures like inflammatory mediators in the blood, which may not accurately reflect what is going on in that specific body part.

P: Dr, what does titrate mean?

Dr. Pro: It means to adjust the amount of medicine given.

P: What is the difference in dangers with inflammation in the glaucoma patient as opposed to people who do not have glaucoma?

Dr. Pro: Well chronic inflammation can cause elevated intraocular pressure (IOP) by sort of clogging up the drain with debris. Also there is the problem in the treatment of uveitis; steroid drops are used to control the inflammation. But using steroids for a longer time (usually over a month) can also lead to higher IOP, especially in people with glaucoma or in people who may be predisposed to glaucoma.

P: Is there a standard course of treatment the doctor follows to treat eye inflammation?

Dr. Pro: Yes and no. First, it depends on why there is inflammation. For the purposes of this chat I think we are generally talking about uveitic inflammation, which means inflammation not due to an infection or immediately after eye surgery. Treatment is generally begun with topical steroids (drops). The drops may be used very frequently at first, and then may be slowly tapered off as the inflammation subsides.

But in some people the uveitis does not improve. These people may benefit from a uveitis work-up, which is lab work to look for causes for this inflammation, such as infections elsewhere in the body, like TB.

Also some people may need more potent oral medicines, or may need steroid injections into or around the eye. These patients may need the help of a uveitis specialist.

P: What signs are there in the eyes that let some one know that they have inflammation in their eyes?

Dr. Pro: The eye can be red, painful, and sensitive to light. The vision may be worse. All these signs and symptoms are reasons to see your eye doctor immediately.

P: Is uveitis painful? What are the symptoms?

Dr. Pro: Yes it can be. Mild inflammation may just cause sensitivity to light, or a mild "soreness" Severe inflammation in the eye can be extremely painful and the vision severely reduced. I would add that untreated intraocular inflammation, especially if it is severe, can cause an irreversible loss of vision.

P: Can uveitis be caused by the administering glaucoma drops over a period of time?

Dr. Pro: Again yes and no. One specific class, the prostaglandins (Xalatan, Lumigan, and Travatan) can cause uveitis in some patients. The other classes are not associated with uveitis.

P: What is a steroid responder?

Dr. Pro: Someone who's IOP goes up after using steroids (usually drops) after a period of time.

P: Will a steroid responder be affected by a seven day prescription of a steroid for uveitis?

Dr. Pro: Not normally, we usually say that it takes about a month or more. Of course, there are always rare cases where a patient's IOP will go up in a shorter period.

P: Once an eye experiences inflammation will it always be prone to inflammation? Can it easily spread to the other eye?

Dr. Pro: It depends on the cause. If it is idiopathic (meaning that we don't know why it is present) then it often will involve the other eye, not always at the same time as the first eye is involved.

Moderator: Thank you Dr Pro! We're out of time. See you in October.

Dr. Pro: Goodnight and thanks for chatting tonight!

On September 16, Dr. Spaeth discussed "Laser Trabeculoplasty" in the Chat room. Click here for highlights of that meeting.

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