Tweet
I have not been on the Dry Eye Zone for some considerable time. My wife's dry eye continues but she has learnt to cope with it quite well. Regular IPL treatments here in Australia as well as regular use of Hyloforte eye drops and Lacrilube (Refresh Nighttime) ointment are her major tools to keep her going. Over the years, steroid eye drops have also had a role in keeping her comfortable, but not without a cost.
For a number of years she was using Pred Minims (preservative free vials of prednisolone) once or twice a day. Then, early in 2015, she was diagnosed with a cataract in her right eye and this was considered to be a steroid induced one. All the time she had had her pressure monitored as she was also prone to pressure response and whilst on the Preds her pressure varied between 20 and 25.
The cataract was a real worry for her as she wanted to avoid cataract surgery knowing it would likely make the dry eye worse. So she stopped using the Preds and switched to using NSAID drops. (There are no preservative free NSAID drops on the market in Australia so Kathy imported Accuvail from the US via GlobalRX pharmacy, but it ain't cheap).
Late last year Kathy's ophthalmologist suggested trying Hycor ointment (a preservative free steroid) on the outside of the eyelid to reduce some eyelid inflammation she was having. She started on this and found it made her eyes feel much better overall. This ointment would supposedly be better for the pressure too as it is not instilled into the eye and "is not absorbed by the cornea as much as pred drops would be".
However, Kathy's pressure did slowly rise - over a few months from 19 to 28. So she had to stop the Hycor too, or at least cut it back.
This brings us to two weeks ago. Kathy had cut the Hycor back to only one use every 3 days and her pressure was back down to 24. Not great but OK. By the Wednesday of that week she stopped the Hycor altogether. The last Hycor ointment had run out at this time and she did not get anymore, thinking to try going without it completely. Then on the weekend some friends suggested a one day ski trip and we decided to do that. Kathy knew it would be taxing for her eyes so she used some old but still in date Pred Minims she had in the fridge. On the Saturday she used one drop, then on the Sunday (the skiing day) 3 drops, and one drop again on the Monday.
On the Tuesday she happened to have an appointment with a new Ophthalmologist for a second opinion about her possible cataract surgery. As part of his regular test he took Kathy's IOP and it was 42 in the Right Eye and 35 in the Left. YIKES.
We were in shock and so was he. He said Kathy had to go on Glaucoma drops immediately and to get the IOP checked again in 2 weeks - he thought it would take this long to go back down. (He said the short term use of the prednisolone over the weekend may have caused this spike but he was not sure).
Kathy was reluctant to start on Glaucoma drops knowing them to be drying. So, instead, 2 days later she saw her local optometrist who normally takes Kathy's IOP readings. This time she was R22 L21. He suggested coming again in 2 days to confirm that she was still low (just in case the higher reading was "correct"). So we did that yesterday and the reading was still low R23 L23.
So, my questions for anyone are -
- has anyone heard of such a pressure spike from a short term use of (possibly stale) prednisolone drops?
- is it possible for pressure to fall from 42 to 22 in just 2 days?, or
- can we just assume that the very high reading was incorrect?
Thanks to anyone who has any ideas.
Neil
For a number of years she was using Pred Minims (preservative free vials of prednisolone) once or twice a day. Then, early in 2015, she was diagnosed with a cataract in her right eye and this was considered to be a steroid induced one. All the time she had had her pressure monitored as she was also prone to pressure response and whilst on the Preds her pressure varied between 20 and 25.
The cataract was a real worry for her as she wanted to avoid cataract surgery knowing it would likely make the dry eye worse. So she stopped using the Preds and switched to using NSAID drops. (There are no preservative free NSAID drops on the market in Australia so Kathy imported Accuvail from the US via GlobalRX pharmacy, but it ain't cheap).
Late last year Kathy's ophthalmologist suggested trying Hycor ointment (a preservative free steroid) on the outside of the eyelid to reduce some eyelid inflammation she was having. She started on this and found it made her eyes feel much better overall. This ointment would supposedly be better for the pressure too as it is not instilled into the eye and "is not absorbed by the cornea as much as pred drops would be".
However, Kathy's pressure did slowly rise - over a few months from 19 to 28. So she had to stop the Hycor too, or at least cut it back.
This brings us to two weeks ago. Kathy had cut the Hycor back to only one use every 3 days and her pressure was back down to 24. Not great but OK. By the Wednesday of that week she stopped the Hycor altogether. The last Hycor ointment had run out at this time and she did not get anymore, thinking to try going without it completely. Then on the weekend some friends suggested a one day ski trip and we decided to do that. Kathy knew it would be taxing for her eyes so she used some old but still in date Pred Minims she had in the fridge. On the Saturday she used one drop, then on the Sunday (the skiing day) 3 drops, and one drop again on the Monday.
On the Tuesday she happened to have an appointment with a new Ophthalmologist for a second opinion about her possible cataract surgery. As part of his regular test he took Kathy's IOP and it was 42 in the Right Eye and 35 in the Left. YIKES.
We were in shock and so was he. He said Kathy had to go on Glaucoma drops immediately and to get the IOP checked again in 2 weeks - he thought it would take this long to go back down. (He said the short term use of the prednisolone over the weekend may have caused this spike but he was not sure).
Kathy was reluctant to start on Glaucoma drops knowing them to be drying. So, instead, 2 days later she saw her local optometrist who normally takes Kathy's IOP readings. This time she was R22 L21. He suggested coming again in 2 days to confirm that she was still low (just in case the higher reading was "correct"). So we did that yesterday and the reading was still low R23 L23.
So, my questions for anyone are -
- has anyone heard of such a pressure spike from a short term use of (possibly stale) prednisolone drops?
- is it possible for pressure to fall from 42 to 22 in just 2 days?, or
- can we just assume that the very high reading was incorrect?
Thanks to anyone who has any ideas.
Neil