Posting on my mum's behalf - glaucoma eyedrops & dry eyes

[mumsadvisor]

Hi everyone!

I'm actually here on my mother's behalf - she doesn't use the internet much and doesn't know her way around the web, moreover she lives 5,000 miles away and has been suffering from dry eyes for a good while now without much support, and I thought this was one way I could actually try and help her. So I hope nobody actually minds that I'm posting on my mother's behalf.

A little backstory: My mother is in her mid-70s and has had open-angle glaucoma for 15 years now, she had trab surgery in both eyes and had blebs, and so far her condition has been stable since. However, a few years after her surgery, her pressure increased so the doc put her on eyedrops - two eyedrops for the worse eye. I have heard about glaucoma eyedrops causing dry eyes because of their preservatives. Luckily my mum lives in a hot, tropical country where the humidity is close to 90+% so she only ever complained about dryness in air-conditioned malls etc. She would complain about her eyes "blurring over" whenever they got too dry, but artificial tears always sorted out the problem.

A few months ago though, the problem seems to be worsening... her eyes would feel 'watery' (although no actual tears would dribble down) and her vision would be blurry. When she last saw the glaucoma doc, he just checked her pressure and seemed to dismiss her issues with her dry eyes, saying she could use Endura eyedrops. So she started using Endura and her vision cleared up, it worked well for about a month after which she complained about 'watery eyes' and blurred vision again and she had to use Endura about once an hour to get relief. My dad started using a combination of Vidisic gel (at night) and Endura during the day but it didn't seem to have much effect. In the end, I asked them to try Genteal gel, which took a few days to "kick in" but after that, the watery feeling stopped and she could see better. However, a few days later, she is again complaining about watery eyes and blurred vision. They are seeing the eye doctor again in a few days but for some reason, they are not particularly hopeful that he will help them with this baffling problem. She is completely stressed out about it though, thinking of the worst possibilities whatever they may be!

Does anyone here know what she means by "the eyes feel watery"??? Is this a symptom of dry eyes or...? She also complains of blurred vision whenever she feels this way. She has already been checked out for other eye problems, i.e corneal, retinal etc. and it was all OK. She also has blood tests every 6 months or so, so I'd assume that most of the other common conditions would have shown up there...

Would appreciate any thoughts.... thank you all for reading.

Jin

[Minni]

I too have watery eyes and blurry vision (the latter at times when my eyes feel dryer & grittier)

Of OTC drops, I've found Refresh Plus and Systane Ultra & Genteal-Gel-Severe to be pretty good.

I personally find that rubbing in VapoRub or White Tiger-Balm or tiny-bit peppermint-oil on temples, to cause refreshing feeling to eyes.

But frankly, I'm scared to advise that for a geriatric like your mom, so on that you're on your own.

[pennyparade]

Watery eyes is absolutely a symptom of dry eyes. It's counter-intuitive but basically the eye is over producing tears to compensate, however, these tears are of poor quality and do little to sooth the irritated surface of the eye. You must ask her Doctor to examine the oil coming from the meibomian glands - is it thick and white? It should be clear and free running. The first and easiest thing she could try is warm compresses and eye washes. A gentle wash of the eyelashes and massage can help the oil flow better. Try a commercially prepared formula available in drugstores (Theralid, Sterilid, etc). Being gentle is key. Do her eyes look inflamed? The best thing you can do is find a doctor with an awareness of Dry Eye Disease to evaluate her. Most eye doctors are woefully unaware of the symptoms and treatments available.

[pennyparade]

Also, forgot to mention: the preservatives in glaucoma eyedrops can exacerbate dry eye. You can have the same medicines made at a compounding pharmacy without the preservatives.

[mumsadvisor]

Thanks for your reply, pennyparade!

Her eye doc is really unconcerned by the dry eye and hardly considers it. The problem is, she has been suffering this problem for a few months prior to her last scheduled eye examination. She complained her eyes were watery and really blurry and she could barely see anything, unsurprisingly, she did badly on the field vision test as well as the other tests for her vision. The doctor worried it might be glaucoma progression and made her return in 2 months. Well, 2 months later, she returned and the results were the same. However, she has been using Genteal eye gel and it has been helping; however the doctor is concerned about her poorer performance in the visual field tests. It is worrying because she has been at or below her target pressure of 18 for the last 2 years. The doc didn't even consider dry eyes as a possibility for the worse VF testing. I've looked it up online and found that it does actually affect tests and doctors should be able to evaluate the pattern of damage to ascertain whether it is likely due to dry eyes or not. I am disappointed with her doctor but she has been seeing him for the past 2 years for her glaucoma and it can't be a good thing to switch doctors again (she was looked after by another specialist for 10 years before that in a different city and she no longer wants to travel so far to see him).
I will ask to see if it is possible at all for the medicines to be made in a pharmacy without the preservatives. Her eyes always look very red and inflamed because of the eyedrops. She has increased her Omega 3 uptake to 4000 mg a day since her dry eye problem manifested.

All very worrying and distressing when her doc doesn't even consider dry eye to be a significant problem.

[mumsadvisor]

PS: I live in London, UK - is this the sort of pharmacy you are referring to? www.specialist-pharmacy.com/ Apparently there is only one. I'm not sure I can get them to make the eyedrops for my mother, who lives in a different country and will need to get a prescription made up by her doctor.

[littlemermaid]

'eyes feel watery' is epiphora, if Googling that will help. When my daughter had it, her meibomian glands were clogged (blepharitis) and we have to use warm compress and careful cleaning to keep her eyes comfortable. Your poor mum. Customer Services at Moorfields Pharmaceuticals may have advice on preservative-free glaucoma drops in other continents - they have an international division. We got much better advice from national and regional eye hospitals, if someone can speak to them in her country on behalf of your mum. We did use ophthalmic saline 0.9% from individual vials (Bausch & Lomb Minims) just sometimes to get a break from chemical eyedrops as the eyes got very sensitive, but not often because the salt solution is not the same as natural tears (osmolarity). There's a good chance her eyes may not close completely when sleeping (lagophthalmos) so an eye mask might help. Many people here use sealed moisture chamber glasses to get some comfort (Dryeyezone website).

[mumsadvisor]

Thanks littlemermaid, I'll get them to investigate the preservative-free eyedrop option, they're not terribly up to date with that sort of thing where she is and I don't think her eye doctor helps either, he simply does not take her dry eye condition seriously at all! Which is extremely frustrating.

The Genteal gel seems to help her, so the watery feeling has stopped but she still complains of her eyes feeling dry and sappy all the time even in a humid environment. I don't know how much that sort of dryness can affect her vision. Her doc just assumes any vision deterioration is due to her glaucoma, but we are REALLY concerned that he isn't looking at other factors too.

[Minni]

The Genteal gel seems to help her, so the watery feeling has stopped but she still complains of her eyes feeling dry and sappy all the time even in a humid environment.

Dry eye definitely affects vision - its the case with me.

When you say "humid environment" - I guess you mean she's not exposed to forced-air heat or drying AC?

If the former, there's always the combo of white-tiger-balm smeared on temples, plus G-Midifier placed right near heat-vent (only in small room, otherwise wouldn't work

[mumsadvisor]

Hi Minni! Thanks for your reply. No, she's not exposed to forced air-heat, she lives in the tropics and sometimes they do use AC but the Genteal helps her cope with that somewhat. During the daytime, they don't use AC.

I guess the big question is does it blur vision enough to affect the visual field tests. My guess is probably yes, but it is pretty crucial here because the doc is recommending surgery but isn't interested in finding preservative-free eyedrops for her! Why do ophthamologists not take dry eye seriously??? This is causing her a lot of distress.

[Minni]

Hi Minni! Thanks for your reply. No, she's not exposed to forced air-heat, she lives in the tropics and sometimes they do use AC but the Genteal helps her cope with that somewhat. During the daytime, they don't use AC.

I guess the big question is does it blur vision enough to affect the visual field tests. My guess is probably yes, but it is pretty crucial here because the doc is recommending surgery but isn't interested in finding preservative-free eyedrops for her! Why do ophthamologists not take dry eye seriously??? This is causing her a lot of distress.

The Refresh Plus is preserv.free, and is OTC.
I think your mom may find it better than Genteal. (I find it better)
Walgreens claims to mimick Refresh-Plus, but I find that to be untrue.
(been there done that. NOT the same.

Of course, better yet is probly FreshKote or drops beginning with the word "hylo"

Have you heard of OPD-III testing?
There's a video on YouTube about it.
Not sure its indicated for your mom, but may be of interest anyway.

[littlemermaid]

Jin, I was wondering why your mum doesn't want to travel to see her former Ophthalmologist? and whether she would get more help with preservative-free glaucoma drops there? Everyone in the world has this worry - how to care for our elderly parents as they grow older - and I'm sure many of us are very sympathetic, having the same problem. It has been difficult to bring my family together to plan for the grandparents' future but we/they have found some relief after tackling the tough questions. One point that came up in our family was that ill health and lack of money can happen to any of us at any age. My husband's sister is almost immobile with MS now, for example, which started when her youngest son (of 4) was 10. Our solution so far includes paying for respite carers (so the full-time carer like your dad gets a break with friends and family). In USA now, I understand there are paid Medical Advocates for care coordination starting businesses and I longed for this to help me with my daughter's conditions - even to the extent of looking for medical student and post-grad health workers to pay and speaking to private GPs - but not found it yet in UK. If your parents are going together to see the eye doc, is there another friend/family who can go along as advocate? I do this occasionally for my husband's elderly friends and my younger friends and it makes a big difference, not least because they feel more like they are consulting a professional and can ask their list of questions rather than be just at the doc's mercy. Maybe your mum's fears for the future are really a separate issue and she's wondering what the options are as she becomes frail. Difficult to discuss but well worth thinking about this early with family.

[LaDiva]

Hello Jin! It is very difficult to recommend an eye drop as different drops are good for different problems. A drop that works for me might not work for your mom. Here is Rebecca's list of eye drops and their contents: http://www.dryeyezone.com/encyclopedia/lubricants.html The only drops that help me are TheraTears in the small vials, but they might not help your mom. I have tear deficiency, MGD and ocular rosacea. I have tried every drop I could get my hands on (there are unused boxes in the back room), and none of them work as well for me as TheraTears. I suspect that the drops I use help to stabilize the tear film since the balance and quality of tears and oil are so off. I am afraid your mom will need to use the hit and miss method as well. Some drops are better suited for oil deficiency, and some for tear. Some drops contain things we can not tolerate. All of the drops with PVAs kill me, but they might work for your mom. Drops, drops and more drops! Best wishes to you. I hope her problem is soon resolved.

[goldiegirl]

I guess the big question is does it blur vision enough to affect the visual field tests. My guess is probably yes, but it is pretty crucial here because the doc is recommending surgery but isn't interested in finding preservative-free eyedrops for her! Why do ophthamologists not take dry eye seriously??? This is causing her a lot of distress.

Hello! Yes, dry eyes can blur vision enough to affect the visual fields test! I also have dry eye caused by use of glaucoma eye drops; however, I'm only 49 years old and have been treated for glaucoma since age 40. My experience is that, when the dryness is at its worse, my eyes get "goopy," producing these stringy, mucousy strands that blur my vision (lovely image, huh?). ;-) Also, a lack of moisture on the eye surface affects how well the eye is able to focus, which can also result in blurriness.

I can sympathize with your frustration about ophthalmologists' seeming lack of concern for dry eye disease. I've experienced the same thing! It seems that they zero in on intraocular pressures, visual fields, and other glaucoma indicators, to the exclusion of other eye concerns. If I were your mother, I would refuse additional surgery until they better evaluate how the dry eye disease is affecting her ability to do the visual field test. If her pressures are stable and there are no new optic nerve changes visible, it would seem very plausible that dry eye could be responsible for the test results. And personally, I have had surgery (with a resultant bleb) in my right eye, but not my left. And although this requires me to take more glaucoma drops in my left eye than in my right (3 vs. 1), my right eye (the blebbed one) is much more uncomfortable from dry eye than my left eye. Therefore, I plan to avoid surgery in my left eye if at all possible!

Best wishes to you and your mum!
Leslie