How is the eye pressure checked?

[oyvind]

Hi,

I'm on a two week treatment of Spersadex (corticosteroid). The doctor said he would measure the pressure after the initial weeks of treatment. I just wonder how he checks the pressure? And could it be harmful to the eye? If thats the case, I'll just quit the drops after two weeks and skip the pressure check.

Øyvind

[irish eyes]

Hi

Put simply, it's like a short puff of air into the eye. You shouldn't feel anything at all; the only strange thing is having to keep your eye wide open and still while the ophthalmologist does it.

This link gives a brief explanation.

http://en.wikipedia.org/wiki/Tonometry

[mary kenny badami]

Hi, Øyvind --

Checking eye pressure occurs at every eye exam I get. I haven't been on eye steroids for many years, and then only briefly after Lasik;
the test is just part of verifying the overall health of a person's eyes -- and for folks such as myself, as one gets older, it helps to assure that you're not developing the problem of glaucoma.

The link from irish eyes (thanks, irish eyes!) explains that the test consists either of a brief puff of air into your eye while the technician or doc watches to see what happens;
or else they put an anesthetic drop into your eye, after which the technician or the doc brings an instrument with a blue light right up to your eye which measures the IOP (intra-ocular pressure).

Please don't skip the eye pressure check, Øyvind. It's brief, it's (far as I know) both painless and risk-free.
Most importantly, it should help your doctor decide whether the drops have done their job so far, and/or to what extent it would be useful to advise additional treatment.

[oyvind]

Ok, thanks.

I'm going to see the doctor tomorrow, so he'll measure the pressure then I suppose. I've been on the drops for 5 days and there is no big difference to the inflammation/pink eye, its actually worse in the morning when I wake up (about 24 hours after use).

Do you think it is fair to conclude that the drops have no effect on me after 5 days?

Regards,
Øyvind

[irish eyes]

Hi Øyvind

Why have you been prescribed the drops in the first place?

It's difficult to say whether 5 days is too soon. It could be that what you can actually see might look the same but the doctor might conclude that the inflammation is receding because he / she can see other parts of your eyes. My opthalmologist expresses concern about inflammation inside of my upper eyelids, the parts that I have difficulty getting to.

I would go along with the drops for the time being and see what the doctor says. Please don't worry about short term use of steroids. I suffer with another eye condition and I'm grateful for steroids. If they didn't exist, I would certainly have lost the sight in one of my eyes so I know what powerful drugs they are. I have my eye pressure checked regularly and it's always been fine.

Mary is right - don't skip the eye pressure test - and let us know how things go tomorrow.

[oyvind]

Thanks for your reply irish. I'll definitely follow your advice and see the doctor tomorrow.

The information I filled in the registration form basically covers my condition:
- Scratchiness, Soreness, Redness, Burning, Eyes tire easily

This is what I told the doctor as well. The redness and soreness is what bothers me the most. The doctor could see that my eyes were "bothered" in some way, but couldn't tell what could be the cause. He didn't test me for dry eyes (I don't know if doctors around here have even heard of it). So first he told me to try some allergy drops, but I've already tried them and they only work for a short period of time (they are called Spersallerg and have vasoconstrictors). Hence, from his lack of other ideas he subscribed these steroid drops to me, so I thought I'd give it a try, especially since my condition has worsened the last year.

Do you think there is anything more I could ask him tomorrow? I'm at a dead end here and have no idea what to do. I'm thinking maybe it is rosacea, and maybe it has worsened from the occasional use of Spersallerg. The doctor denies it.

[oyvind]

Went to the doc today. He denied occular rosacea as he had not seen it without the skin rosacea. The pressure was fine, he didn't think I could have dry eyes as he saw tears and what have you.

Anyhow, I seem to react to something in the drops, as my eyes are really, really red in the morning. Can the steroid drops or maybe the BAK be harmful vs the redness you think?

[irish eyes]

I'm pleased that the pressure is OK! Are you going to continue with the steroids for a while longer? It could be that the preservatives are not helping you; that is a problem I have. Your doctor might be right in thinking that the vasoconstrictors hadn't caused damage because you used them for such a short time but of course I might be wrong thinking that.

Did the doctor reach the conclusion that you didn't have dry eyes just because there were some tears? It could be that you are producing tears but they are of poor quality and evaporate quickly.

I know how frustrating this must be for you; I am not a good advert for a successful outcome because I was given contradicting diagnoses and my eyes have become worse as a result. It was even suggested that much of my discomfort was down to emotions! How can doctors prescribe the right thing if they cannot diagnose in the first place?

Have you seen this article on testing for dry eye? (Ignore the header - aging eye)

http://www.agingeye.net/dryeyes/dryeeyeseyeexam.php

(My husband used to travel to Norway quite a lot and he always said the climate would be ideal for my eyes!)

[oyvind]

He based his conclusions on what he saw, yes. No tests or anything.

I called him later and asked to be forwarded to the hospital. I'm going there to ask for some kind of surgery as my lower lids are really low. The waiting time is probably 4-6 months though, and its not certain that they will accept my case for revision.

Also, I have lagophthalmos, the night version, where I sleep with my eyes half open sometimes. Again, the doctor denied this could be the cause of my problems. And I agree to some extent, because I've had it all my life. But it is not helping either.

I'm on my way to the primary doctor now, so I'm going to ask for doxy. You think that could be helpful in my case? From what I've read it is useful for some, whereas others don't find it helpful at all. I don't know if I'll get it though, they're restrictive in this country with antibiotics.

[irish eyes]

Hmm. Tests aren't everything but it's a start.

Have you done a search on this site for other people who have lagopthalmus? I think the surgery you refer to is tarsorrhaphy but correct me if that's not the case. Dr Latkany mentions it in the Dry Eye Remedy; it works for some but he says it is a last resort. I don't suppose lagophthalmus is helping your condition all the same.

How about artificial tears without preservatives - have any helped? I find it is often hit and miss - and mainly miss where I'm concerned.

Doxy might help. I have taken it for years but don't know how helpful it really is. The consultant advised me to increase the dose from 50 to 100 - he added that with some people, it can be almost impossible to get rid of low grade infection. I take acidophlous to restore loss of the good bacteria that would be killed off by doxy. There is evidence of severe inflammation in and around my eyes, that's for sure so the doxy makes sense in my case - even if it is only mildly beneficial. I would certainly mention it to the doctor.

[oyvind]

I'll do a search, it could be that others with lagophtalmos have found some remedy. I've had no avail from tranquileyes.

Decided to stop the steroid drops due to the reaction and had no help from them.

I did get the doxy, although she was very reluctant and explained all the risks involved. Is it that bad for your body? The dosage was 200mg the first day, then 100mg for 5 days and then end it. How is your dosage? Will this cause me any problems with the bacteria flora? I'll start the treatment next week as I'm heading north (fairly cold). I do want to spend a few days in the sun this weekend.

No artificial tears has helped thus far. I mainly try them for a few days at a time which might not be enough, but my eyes react to anything foreign. Have you got any favourites?

[irish eyes]

I didn't get any relief from Tranquileyes either.

The reluctance to prescribe doxy surprises me - would this be the case for all conditions or is it because it's your eyes?

Doxy causes some people problems but I don't think it really affected me in a way that I would notice. I have developed a stomach ulcer over the years but I attribute much of that to the stress of coping with life with dry eye and everything else that goes with it. My GP tends to agree so rather than take any more pills, I watch what I eat. It's certainly no hardship but I would like to relax it a little and be more spontaneous.

Like all medicines, Doxy will have a list of possible side effects. You wouldn't notice any immediate benefits - it would need around 6 - 8 weeks to establish itself.

Favourite drops? I have used so many but none have helped. Just now, I'm swapping Vismed for Systane - and then I will swap back again. Something happens with my eyes that they start saying `no' after a while. Is there a reasonable choice available in Norway?

[oyvind]

The reluctance to prescribe doxy surprises me - would this be the case for all conditions or is it because it's your eyes?

When I got the prescription, my GP noted in my journal that I merely forced her to give me the doxy, lol We laughed at it though, and I told her no problem I'm desperate. It was just to clear her back from any issues with the supervising authorities.

I think this is the case in Norway for most conditions where doxy and the like are not obvious as a helpful medication.

I could override the doctors prescription and do 50mg per day for 20 days. You think that would be more helpful? I think Latkany mentioned in another post that this would be his preferred route.

We have Systane with conservatives over here, plus a few others. I've tried them all with no relief, and concluded that I don't think I have dry eyes. This might be very wrong though, but for know I'll concentrate my endeavours in other areas.

Seemingly I react to BAK and everything else thats in eye drops anyway.

Have you tried pataday? I would maybe like to try it, but don't know where to get it.

[irish eyes]

Oyvind

I trust your doctor has your best interests at heart - I am sure she wouldn't have prescribed it if she was in any doubt at all. She should have checked that your blood pressure was OK and probably asked you a few questions about any aspects of your general health (other than your eyes....?)

Your doctor will know that doxy is used extensively in 3rd World countries because it is anti-malarial. People who regularly travel to those countries take it as a routine preventative measure - but those of us with bleph take it as a treatment so there is a difference.

Doses - doctors usually suggest a stronger dose initially to `get going' but then reduce it. As I said earlier, you need a few weeks for any difference to be noticed. Dr L gives a case study of someone seeing a difference in 3 weeks although I don't think he mentions the strength of the dose.

I haven't tried Pataday - isn't it an anti-allergy drop? It's not something we can get in the UK. I think you should be able to get it on one of the drug websites but it might need a prescription - which could be problematic if your doctor is hesitant about these matters.

[oyvind]

Thanks for your quick replies irish eyes. It is much appreciated.

I've been extensively checked within the last year due to tiredness and have taken at least 50-60 different blood tests for that. Nothing has been found to be wrong.

Nowadays it is mostly the eyes that bothers me, the tiredness is less dominant, but still present. I just think I would feel much better if my eyes were ok. I've discovered that I have to evaluate and redefine my lifestyle somewhat because of this. I'm hopeful that 3 weeks of vacation will have a positive effect though.