Chat Highlights
Common Sources of Eye Discomfort in the Glaucoma Patient
June 21, 2000

Norma Devine, Editor

On Wednesday, June 21, 2000, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Common Sources of Eye Discomfort in the Glaucoma Patient." 

Moderator:  Welcome newcomers and old timers.  Tonight we will discuss "Common Sources of Eye Discomfort in the Glaucoma Patient" with Dr. Rick Wilson.  After the discussion, please feel free to ask general questions. 

P:  Would pain from moving the eyeballs side to side and up and down come from glaucoma or dry eyes or some other medical problem?  I was diagnosed with Open Angle Glaucoma on May 31 this year.  

Dr. Wilson:  That's unusual for straight glaucoma.  The pain is  more likely from a reaction to drops, dry eyes or something unrelated.

P:  Are dry eyes a result of glaucoma?

Dr. Wilson:  No, but medications, especially Alphagan, can make your eyes feel dry.

P:  Are dry eyes common with glaucoma?

Dr. Wilson:  Yes.

P:  I have a foreign-body sensation in my eye after a trabeculectomy.  Why is that?   

Dr. Wilson:  That can have at least two causes.  The eyelid, as it wipes tears across the eye, hops from the top of the bleb to the cornea and misses a small area at the top of the cornea next to the bleb.  This area dries out and becomes sensitive.  The other cause is a naturally dry eye with a bleb that is bumpy, perhaps with a suture sticking up.  As the eyelid rubs over it , it feels rough and sensitive.

P:  I have a foreign-body sensation in my eye after using Xalatan eyedrops.  Any suggestions?

Dr. Wilson:  Xalatan often causes a red, sometimes uncomfortable eye, but not usually an allergy.

P:  I also use Xalatan and have been having redness in my eye for the past four days.  What are the symptoms of chronic dryness? 

Dr. Wilson:  Dry eyes feel scratchy, tired, heavy lidded, and like something is intermittently in the eye.

P:  Do over-the-counter drops for dry eyes have any effect on IOP?

Dr. Wilson:  No, you can use artificial tears like Refresh Tears or GenTeal every five minutes, if you need to.  The other thing to remember about artificial tears is that they are drained away fairly rapidly and their effect only lasts about 10 to 15 minutes.  If you want something more long-lasting, try GenTeal Gel which blurs the vision for 20 minutes, but can last six to eight hours.  The  next step after that would be to have the inferior punctum plugged, so the tears are not drained off too quickly.

P:  That's invasive?

Dr. Wilson:  The plugs are inserted at the slit lamp in the office, so I don't consider them invasive.  They can be removed at any time.

P:  Thanks for information about the plugs.  Is there any downside to that?

Dr. Wilson:  Not usually, unless you are making excessive tears; then you go from dry to too wet.  My Mom just had the punctum plugged.  

P:  Can you tell me more about the plug-ins? 

Dr. Wilson:  I would try the Gel first.  If that is ineffective,  I see few downsides to the plugs.  If you want to see the effect, you could try those made of collagen that dissolve after a few days.  

P:  Last week my eye felt a little uncomfortable and I was a little dizzy.  My tube opened up this week.  Could the opening of the tube have caused the weird feeling in my eye?

Dr. Wilson:  Absolutely.  

P:  Can the artificial tears themselves cause irritation?

Dr. Wilson:  The artificial tears with a preservative in them can cause irritation.  That is why I mentioned GenTeal and Refresh Tears.  

P:  Then preservative-free artificial tears would cause fewer problems with irritation?

Dr. Wilson:  In people sensitive to the preservatives, yes. 

P:  I am using Cosopt, Xalatan and Alphagan simultaneously.  I also have blurred vision constantly.  Would these medications contribute to blurred vision and loss of peripheral vision?

Dr. Wilson:  The medications could cause blurred vision, but so could the glaucoma,  which is the likely cause for loss of peripheral vision.

P:  Is there any possibility that the peripheral vision will return or can be restored in any way?

Dr. Wilson:  If the eye pressure is dropped low enough, there is the possibility of a slight return. 

P:  Doctor, I asked about dryness in the middle of the night.  It feels like my lid is glued to my eyeball, especially where the patches of sclera are.  Should I worry, or is this normal?

Dr. Wilson:  That's not normal.  Start with GenTeal Gel at bedtime.  If it doesn't last overnight, so your lids glide easily us in the morning, use Hypotears ointment or Refresh PM at bedtime.  Just wipe the goo off in the the morning. 

P:  If your eyes are irritated and red, is that always from an allergy or dry eyes or could it be from  high pressure.  I do not know when I should be worried and when I should not be.  Can you help, please?

Dr. Wilson:  Itching is usually from an allergy.  Redness could be inflammation, allergy, extreme dryness, and even more things, but usually not from chronic high pressure.

P:  My first visual field test results were fine.  But originally my ophthamologist said there appeared to be some nerve damage.  Should I go for a second opinion, even though now he's saying there's no damage?

Dr. Wilson:  It depends upon whether you feel comfortable with his competence in glaucoma.  If you are uncomfortable, a second opinion would help you rest more easily.

P:  What about eye pain?  Short of having IOP tested every single time you have such discomfort (impossible in most cases), is there any way to tell if the pain is related to pressure?

Dr. Wilson:  It might be possible to feel your eyes by putting your two index fingers close together and pushing with one and quickly releasing the other, followed by reversing the actions of the two fingers.  That will give you a sense of the pressure in the eye.  Try to validate your impression when you go to the eye doctor.

P:  I've recently felt intermittent aching in my hypotonous eye.  Is that something to be concerned about?

Dr. Wilson:  It is not unusual.  But if it is new for you, perhaps you can have it checked out.

P:  I have had a trabeculectomy, cataract surgery, and a tube shunt in my right eye.  Vision before the tube shunt could be corrected to 20/30.  Four days after surgery, I completely lost vision for 24  hours in that eye, and now vision in it can only be corrected to 20/70.  That eye  has constant, excess tearing and discomfort.  Is excess tearing normal and will vision eventually return?

Dr. Wilson:  How long ago was the surgery?

P:  The surgery was December 21, 1999.  

Dr. Wilson:  It sounds like your bleb may be working too much.  If your pressure is low, your vision will not be as good. 

P:  What  about a foreign body sensation in the eye after Xalatan use and blurred vision for five days? Will these symptoms ever go away?

Dr. Wilson:  That could be intraocular inflammation, so it should be checked.

P:  What are the symptoms of intraocular inflammation? 

Dr. Wilson:  The symptoms are a red eye, light sensitivity, ache, and possibly a small pupil.

P:  What is the treatment for the intraocular inflammation?

Dr. Wilson:  The treatment is steroids or Motrin-like medicines.

P:  After I used  Xalatan once, my pressure went down from 18 to 14, but my vision was badly blurred.  I stopped using Xalatan.  The affected eye that got the drop looks smaller than the good eye.  Is this normal?

Dr. Wilson:  Most people's eyes are elastic, a little like balloons.  If you lower the IOP,  the globe shrinks,  the lid droops, and the vision is not as good.

P:  Rick, why do glaucoma patients suffer discomfort from bright light? Is that from the medications or from the glaucoma itself?  

Dr. Wilson:  Usually light sensitivity is due to corneal problems or intraocular inflammation.  Drops can cause both.

P:  So there is no solution for glaucoma patients who suffer from light sensitivity, because we need to use the eyedrops, which cause the cornea problem.  Is that a cause for concern?

Dr. Wilson:  Usually not.  

P:  What about intense pain when trying to read at night?  I get sharp pains across the brow of my one good eye.  I read a couple sentences, rest, then read some more, etc.

Dr. Wilson:  When reading, I would use plenty of  artificial tears, maybe every 15 minutes.  I would also be sure the glasses and eye alignment are correct.  

P:  My eye hurts if  I watch TV for more than half an hour.  Any suggestions?

Dr. Wilson:  Check your glasses and use artificial tears.  If all else fails, check eye alignment.

P:  Can too much reading be harmful to eyes with lens implants of different foci--one for close vision, the other for far vision?

Dr. Wilson:  Not that we know.  

P:  Pressure in my right eye stays around 10 and 12 since the tube.  Is that  too low?  If so, what can be done?  I never had that problem before.  By the way, what is a "bleb?"

Dr. Wilson:  Pressures of 10 to 12 are  usually good,  but I have several patients for whom  pressures in this range cause folds in the retina, as the sclera shrinks and causes vision to blur.  A bleb is the bump on the top of the eye, under the eyelid,  where the eye fluid drains out after a trabeculectomy.

P:  I am on Acular for a temporal injection.  What is a temporal injection?  My eye was one-third red, funky looking in the white part and ached.  

Dr. Wilson:  Temporal injection means the temporal side of the eye was red with enlarged vessels. 

P:  A year after my trabeculectomy, my IOP is holding at about three.  Is that too low?  

Dr. Wilson:  That is why your vision is poorer.  

P:  Dr. Rick, all of my eye problems stem from Reiter's syndrome.  My 14-year-old daughter also has Reiter's.  In what ways other than routine eye exams can we protect her from going through the same extensive surgeries and procedures that I have had?

Dr. Wilson:  None are known now,  but our medications are getting much better, so her course should be much better than yours.  That is, probably, but not necessarily.  

P:  What is Reiter's syndrome?

Dr. Wilson:   Reiter's syndrome: combined findings of urethritis, arthritis, inflammation of the conjunctiva or iris.  Unknown cause.

P:  Is there anything safe that I can use for arthritis?  What about Relafen? 

Dr. Wilson:  That should not raise IOP.  I take 1500 mg/day.  The only arthritis drug that raises IOP is steroids, either as drops or even as oral agents.

P:  I get pain in my right eye, and it feels swollen and looks bigger than the other one.  Is this reasonable, or is something really wrong?

Dr. Wilson:  I can't tell over the Internet.

P:   What do you know about nitric oxide that researchers are studying? 

Dr. Wilson:  It is a by-product of cell death.  It is possible that if it actually causes something and is not just a marker of something happening, we will be able to block its effect.

Dr. Wilson:  I've got to leave slightly early tonight,  as I have to be at the New Jersey office tomorrow at 7:00 a.m.  

Moderator:   Thanks Dr. Rick.  Good night.

End of highlights for June 21st chat.

On June 28, Dr. George Spaeth discussed "Unconventional Treatments for Glaucoma" in the Chat room.  Click here for highlights of that meeting.

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