Glaucoma and Dry Eyes - newbie "intro"

[hiwaygal]

Hello!

I was diagnosed with glaucoma about 4 years ago. My IOP's were up near 30 in both eyes (I think one was 30 and one was 28). I was started on Lumigan, 1x/day. That worked for about a year and a half or so.

About a year ago, it stopped being as effective and my IOP was up again into the mid/upper 20's. My opthamalogist switched me to the Combigan drops 2x/day.

At last check, the IOP's were in the low/mid 20s. We're sticking with the Combigan for now. Also at my last check (in September) I told my opth that my eyes felt gritty and tired. He checked and said I have dry eyes. He prescribed Restasis, told me it would take some time to build up and become effective. He also gave me Allrex to use for awhile to help ease the burning of the Restasis and a bottle of Refresh Optive and told me I could use that (or another brand) as often as I like.

It's been 2 months and my eyes have gotten worse instead of better. I'll admit I don't use the regular drops often, but I'm starting to. Sometimes as much as every hour or so.

My eyes are so red. Really really red. Everyone asks if I've been crying.

And now all the other symptoms are becoming so much more bothersome. The blurry vision is making it hard to do a lot of things. I'm not sure I can continue driving at night, and even coming home from work in the evenings is getting scary.

I work at a computer all day and by the end of the day my eyes are so tired I have headaches and there is so much pain. I wake up with headaches and the stress is causing neck and back pain.

So...essentially dry eyes is having a much more significant effect on my life than I ever thought.

I called my opth last week to ask to see him or if there was something else I can do. His nurse/assistant called me back and said it could take SIX MONTHS for Restasis to work.

Are they SERIOUS?!?!?!

There is no way I can tolerate this for another 4 months.

I do have an appointment in January to do a visual field test for the glaucoma. I intend to talk to him again then, but I'm just so frustrated.

Really, it takes six months for this stuff to work?

I'm going to try some of the other things here (computer reminders to take breaks, compresses, etc)...but hopefully you all can offer something more. Even if it's just a cyber shoulder to "cry" on or for support.

Thanks for reading all this!

D

[Nanerpus]

I by no means am an expert or long term DE sufferer, but a "newbie" myself. But, this summer and the past fews months it has increasingly debilitated me in a way I never thought possible. I understand how much it affects your life. I no longer am able to do the things I enjoy, like yardwork, trail runs, or riding my beloved horses anymore without my eyes getting red and irritated and dry and I'm officially now depressed from it. I know that sinking feeling when your eyes start to get red, when you do look like you've been crying and you haven't been, and how simple things (driving home from work for you) are now difficult.

I'm curious about your glaucoma? I hope I'm not being rude so don't answer if you dont' want to, but just wondering how/why your eye doc thinks you started getting it?

I'm actually going into my eye docs today and going to ask for plugs. So far, I've tried LOTS of artificial tears/gels, etc. , night goggles, wraparound sunglasses, humidifier, Flax/fish oils & hyaluronic acid and I've been on Alrex on and off for about amonth at a time for various things, mainly my stupid, ugly pinquecula (little area of uneven skin from wind damage) getting inflamed since I don't have enough tears to lubricate it.


My advice, is to ask WHAT kind of DE you have: MGD? Aqueous Deficiency? A little of both?

My wrench thrown into this whole thing is that last month I developed ALLERGIES for the first time - my eyes got REALLY RED and itchy and irritated. Looking back, theyve been a little like that all summer so I'm wondering if it was just leading up to this big attack. I'm now on Pataday, have been allergy proofing my house as much as possible, and will be getting allergy testing done next month.


I just wanted to share a little of my story to let you know you are NOT alone and you WILL figure this out. Find a great doctor and just keep plugging away at tips you read here, and trying things.

Best Wishes,

N

[Happymeal]

Hi,

Sounds like you're in a similar situation to me, although i'm currently classed as having intraocular hypertension and not full blown glaucoma. My IOP's are mid 30's untreated and mid 20's when treated with Lumigan once a day, which has been my treatment now for the past 18 months).

It was my dry eye problem that came first, and in investigating that my optician discovered the high IOP's so referred me to an opthalmologist. Long story short, that was end of 06 early 07 from then on I had two and a bit very bad years with my dry eyes (MGD in my case), probably made worse as alot of anti glaucoma drops are known to have dry eye side effects. Maybe this is something you could discuss with your opthalmologist, as different people react differently to different types of drops, you might find some drops suit you better than others.

All the best.

[hiwaygal]

Thanks for the replies! It really just helps to have others to talk with.

Nanerpus - the glaucoma diagnosis has bothered me before. When I was diagnosed, I started looking for information. Basically what I found was that the glaucoma diagnosis usually means there is some damage to the optic nerve.

However, I had 20/20 vision. When I went back for my first follow-up, I asked the opth. He said that when the pressures are that high, it's not an "if" you develop optic nerve damage, it's a "when" so they usually diagnose it as glacoma. It might depend on the opth though too.

I had issues with that opth and switched to a different one, he didn't seem to have any issues with the glaucoma diagnosis either. So I don't know.

I do know that I have no family history and NONE of the known risk factors. Just lucky I guess. And from my research, there is no way to know or no way to really prevent the onset of glaucoma. But you can slow/stop the progression with various treatments (eyedrops being the 'easiest').

Until I started reading more about the dry eye stuff, I didn't know there were different types. I'm guessing some of mine may be a side effect of the glaucoma drops, hormonal (mid-40's), and who knows what else. I will ask about the type at my next visit.

You've tried so many things to help...what things do you think were the best value? What helped you the most?

Happymeal - It seems like I'm going to have A LOT to talk about with my doc!

Sometimes it's hard because he seems to be a little condescending. I might have to just set him straight this next visit! LOL

I just don't know if I can even wait 'til January.

Happened to see my GP yesterday and she suggested some adjustments in some of my other meds (for anxiety) and to see the opth and basically MAKE him do something. UGH...you'd think they would want to anyway, you know?

[rooneyandfergie]

I do know that I have no family history and NONE of the known risk factors. Just lucky I guess. And from my research, there is no way to know or no way to really prevent the onset of glaucoma. But you can slow/stop the progression with various treatments (eyedrops being the 'easiest').

I wouldn't call that lucky though. Hi hiwaygal, I was also diagnosed with glaucoma/ ocular hypertension officially in May this year. I am not sure because apparently 2 doctors said my visual fields were normal. 1 said i had some visual loss in the right side. It was a devastating blow to me.

To be very frank, dry eye bothers me more than glaucoma. Dry eye discomfort has really made a lot of the daily stuff difficult. I did have a bit of dry eye discomforts before going on glaucoma eye drops. I am now using Xalatan. You mentioned Lumigan is a prostaglandin eye drop and hence is bound to cause quite a bit of redness. Combigan has a beta blocker inside. I was discouraged from using a beta blocker because i was told it had more systemic side effects. The redness in my eyes is the hardest thing to accept.

When i first used Xalatan, my eyes burned like hell and I had hives on my eyelids and also my ears turned very red. Subsequently, my face and ears will turn very red and feel warm like i am having a hot flash. did u have that while on Lumigan? how bad was the redness Lumigan caused?

I also subsequently had sinus issues. Did you have that after using Lumigan? I am thinking of asking the doctor to let me go for 3-4 months without any glaucoma eye drops to see if my eyes improve in comfort after that. I am thinking of adopting a close monitoring regime and reapplying the Xalatan again when there is definite visual field deterioration. I saw an Ocular hypertension study done which states that in the next 5 years only 10% of ocular hypertension patients get glaucoma. My pressure is fortunately a bit lower when i checked it before starting Xalatan around 25. The doctor did give me the option of monitoring then but he recommended starting treatment immediately. I cant imagine the prospect of suffering the side effects of the drops for the next 50-60 years.

Unfortunately Restasis does take some time for it to take effect. You need at least 3 months to feel an improvement. 6 months is when the medicine usually takes full effect. However this is a general guideline. Some people need longer. I started on Restasis for 3 months. It wasn't really that effective. I was then upgraded to a stronger version, cyclosporine at 0.5%. that's 10 times the concentration of restasis. It has been more effective than Restasis but causes very bad burning and also redness. If you want immediate suppression of the inflammation and comfort, the next choice is to use Lotemax or Alrex (lesser strength).

But since you have glaucoma, I dont have to tell you what the side effects of steroid eye drops can do to your condition. Life's a big joke isn't it? The glaucoma eye drops cause your dry eyes. To treat the dry eyes, you may need steroid eye drops. Steroid eye drops in turn aggravate your glaucoma. It's like everything is meant to screw you. LOL

I really don't know what can be done about the redness. I am looking for an answer myself. But if you're still on glaucoma eye drops, that will be difficult to eradicate. Have you enquired about SLT? Maybe you can wean yourself off drops. Try omega 3 (dont feel that that really works for me though) as well and as Nanerpus said, you need to find out whether you have evaporative or aqueous deficient dry eye.

[hiwaygal]

Well, I went to a new opthamologist last week. Told them I wanted a second opinion.

He believes I had/have allergic conjuctivitis - an allergic reaction to the preservative in the Combigan (glaucoma drop).

He stopped me on that, gave me some steroidal drops (Lotemax) to help ease the pain/redness, and also suggested a different glaucoma drop that does not have a preservative.

Our pharmacist had never heard of this preservative free drop and we did an internet search and gave her the information, she found it and we picked it up today. The stuff is $630 for a one month supply!

Anyway, I see the new opth tomorrow for a follow up.

I asked him to make the old opth aware of his diagnosis and treatment.

I may not go back to the old opth. It's not really his fault for what happened, he may not ever have received the message that his nurse responded to.

But, I can't help but feel I was "brushed off" when this could have been helped!

My eyes are doing much better. Still dry (still doing restasis) but not as blurry or painful or red.

~~~~

To answer some of your questions rooneyandfergie:

I never had any reaction to the Lumigan other than the occaisional "post nasal drip" if I didn't give the drops enough time to absorb. The only reason we stopped the Lumigan was because it had become ineffective in lowering the pressure.

I also never had any discomfort with glaucoma. My understanding is most people have no symptoms at all...and if they do have vision loss, it is usually permanent.