Can high eye pressure damage the optic nerve?

Hi,

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As you have described above that your both eyes got operated for cataract and multifocal intraocular lenses implanted and now you had retinal attachment surgery (most probably pars plana vitrectomy PPV plus silicone oil) about two months back, which is now causing increased IOP - intraocular pressure called secondary glaucoma. First, it is very good that you got operated for retinal detachment in time and your vision recovered. You have not mentioned about posture after RD surgery? Have your doctor advised to keep face down or head straight or sideways?Now, let me answer your questions one by one in simple words. Increased IOP is a very common problem in eyes with silicone oil injected after retinal surgery. When silicone oil starts emulsifying very small bubbles block outflow of water inside the eye (aqueous fluid). When more aqueous is produced and less fluid gets out of the eye, the pressure inside the eye increases. This is called increased IOP. If you used to lie straight in bed, then silicone oil (that floats on water) pushes lens and everything forward and can increase IOP. IOP of above 21 is considered high. If it is for a short time, then it does not cause much damage. But, if it persists for a long time, then it can cause permanent damage to the optic nerve. To control high IOP, drops are used. It decreases the production of aqueous in the eye like your doctor has prescribed you Timolol and Brimonidine. If the IOP is not controlled with these two drops, then consult your doctor for some other drops like Latanoprost. Another thing you can do is avoid lying straight with face up. You can keep your face down or lie sideways as that will also do little help in IOP lowering. Silicone oil is usually removed after three to six months, unless it is required for longer in special cases. But, before the removal of the oil, we need to make sure that the enough laser or cryo have been applied to retinal holes or breaks to minimize the chance of retinal re-detachment. Please check the response of the current drops. If IOP is not controlled and your doctor feels safe, then he will remove silicone oil (complete or partial). I am sure your doctor is doing a great job and you can discuss with him about starting another drop or silicone oil removal if he feels satisfied with the retina status. Trust your doctor and he will do the best for you. Power of eye having silicone oil is changed (about three to four diopters), so you might need glasses temporarily until the silicone oil is removed.

Hi,

Welcome back to icliniq.com.

Actually, posture advise is according to the location of a hole or break whether it is posterior or peripheral, superior or inferior, etc. The position should be such that the maximum temponade of silicone oil should cover the break. Your doctor knows the better location of the break and he would have advised you accordingly. Posturing is usually advised for first one week. It can affect intraocular pressure minimally. It is good that your retina is fine. Some surgeon applies laser or cryo during surgery and then there will not be a need of postoperative laser. Some surgeon does not do laser. It is the surgeon's decision and what he feels appropriate. There is always the risk of retinal re-detachment after silicone oil removal. All these lasers and cryo minimize the risk of re-detachment. Remember, nobody can guarantee that the retina will not detach again. It is has been doctor's experience and probability that when he feels retina safe, he will remove silicone oil. So, I would not advise you anything as I have not examined your eye. Your doctor is doing a great job and you should trust him. He will give you the best treatment. It is good that he already has treated your left eye break with prophylactic laser, which will decrease chances of retinal detachment. So, keep visiting your doctor regularly. Everything I told you is for your understanding about your eye problem. You can discuss with your doctor and do as he advises you.