Chat Highlights
Glaucoma and the Cornea
October 18, 2000

Norma Devine, Editor

On Wednesday, October 18, 2000, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Glaucoma and the Cornea." 

Moderator:  Welcome Dr. Wilson, tonights topic is Glaucoma and the Cornea.  We have several people with a special interest in this topic.

Dr. Wilson:  How is everyone's cornea?

P:  Not so good.   I have Fuchs' endothelial dystrophy, cataracts, and glaucoma.  Are they related?

Dr. Wilson:  You're right, although the hallmarks of Fuchs' dystrophy are cataract, chronic inflammation, and iris atrophy.    

P:  How does glaucoma affect the cornea?  

Dr. Wilson:  High pressure can injure the cornea. The chronic use of some glaucoma medications may hasten the slow loss of the endothelial cells lining the cornea, the ones that keep the cornea clear.

Moderator:  Which medications can harm the cornea like that?

Dr. Wilson:  I remember that epinephrine compounds can do that.   I'm not sure if any other ones have been proven to hurt the endothelial cells. Trusopt and Azopt do not hurt endothelial cells, but can cause unhealthy corneas to swell slightly.  That is a reversible phenomenon.

P:  Would you explain superficial keratitis? 

Dr. Wilson:  Superficial keratitis is an inflammation of the top layer of the cornea; there are five layers. 

P:  Is corneal injury visible when the doctor checks the eye pressure or are special diagnostics required?  

Dr. Wilson:  Special enlarged photographs are necessary to see the endothelial cells well. A special ultrasound can measure the thickness of the cornea.

P:  Does a trabeculectomy make a cataract grow faster, and could that be within six weeks?  My vision is getting cloudy, especially early in the morning.  Also, I'm not getting my vision back as fast as I think I should after the surgery. 

Dr. Wilson:  Trabeculectomy often makes a cataract grow faster.  If the IOP drops very low, the cataract can form rapidly.

P:  My daughter just had a corneal transplant.  At the same time, she had a glaucoma surgery that didn't work.  The pressure is now 49 mm Hg in the operated eye. Before she had a transplant,  her cornea was so painful she could hardly do a thing and was on pain pills. What would have caused the pain?

Dr. Wilson:  Corneas that fail are thick and filled with extra fluid. The fluid may take the form of bubbles that form on the surface. If they break, raw spots are left that can be quite painful. The uneven surface of the cornea can also be very sensitive.

P:  My daughter said the Muro burned something fierce.  

Dr. Wilson:  Muro is a salt solution, so it can burn. It is meant to draw fluid out of the swollen cornea.

P:  Can corneal injury cause glaucoma?

Dr. Wilson:  Yes.  If the injury is great enough to injure the drain (trabecular meshwork) as well, the drainage will be compromised.  If there is a hole in the cornea so the front of the eye collapses, then the iris can move forward and get caught in the drain, blocking it and causing glaucoma.

P:  Can Xalatan cause cornea problems?  I have trouble wearing my contacts since I started on Xalatan?  

P:  I'm also having trouble with contacts.

Dr. Wilson:  There are toxic reactions in the cornea from Xalatan in a few patients, some that look like virus infections. Your doctor should be able to see it, though.

P:  How can patients tell if they have a damaged cornea?

Dr. Wilson:  Decreased vision and eye irritation are the only way to recognize corneal damage.

P:  But how can we distinguish irritation from cornea damage from eye irritation caused by drops?  

Dr. Wilson:  Corneal irritation is often accompanied by light sensitivity and serious pain.

P:  Is there anything, such as diet, exercise, or eyedrops that help to prevent damage to the cornea? 

Dr. Wilson:  Multivitamins may help, depending upon your nutritional status. Lubricant drops without preservatives can be used copiously if your eyes are dry or irritated.

P:  Do lutein, rutin, or bilberry help the eyes?  

Dr. Wilson:  Lutein is thought to be helpful, as are most antioxidants.  But the full story is far from in. I would take a multivitamin a day (with iron, if a woman) and 400 IU vitamin E, and eat kale, spinach, broccoli, and green, leafy vegetables. Green tea and even chocolate also contain antioxidants. Unfortunately, you need to eat a lot more kale than chocolate.

End of highlights for October 18th chat.

On October 25th, Dr. Rick Wilson discussed "Lasers, Medications, and Surgery " in the Chat room. Click here for highlights of that meeting.

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