Q. Can high eye pressure damage the optic nerve?
Hi doctor,
I am 65 years old. I developed partial retinal detachment in the right eye. An urgent surgery was done and a silicone oil has been filled. This happened around two months back. The vision field is restored and the retina is reported to be well attached. But, about two weeks back the pressure of the eye has raised. After surgery, it was in the range of 20-21 mmHg and now it is 32 mmHg. After surgery, my doctor prescribed Timolol maleate drops twice a day. Since last five days, it has been changed to a combination of Brimonidine and Timolol. But, the pressure is still 32 mmHg. I also feel that my eyes are sticky and a bit swollen. Though my vision field is full, it is blurred to the extent of 50%. I can see objects, colors, etc., but cannot make out the letters. Self-illuminated letters in big size are visible from a distance of 10 to 14 feet. Of course, I have to wear my earlier glasses. My eye was operated for RK before 30 years. I underwent cataract surgery seven months ago in both the eyes and was fitted with Toric Multifocal lenses. I am on medication for the past seven years for mild hypertension and diabetes. I have attached my current medication list for your reference. I wish to know the reason for high eye pressure. Is the value safe? Will it cause any damage to the optic nerve? How to bring it back to the normal range? Please explain.
Hi,
Welcome to icliniq.com.
- 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 3-4 diopters), so you might need glasses temporarily until the silicone oil is removed.
Revert back with answers to the above questions to an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist
Thank you doctor,
Thank you for the nice and simple explanation. After surgery, doctors advised face down position for a week while sleeping. I guess IOP was fine during the first 15 days as per records. Any change in your advise based on the above? Till date, no laser done as the retina is well attached. It has been examined thrice after dilation and fundoscopy. Of course, left eye has undergone two attempts to fix the breaks in retina by direct and LIO procedures that included HST.
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.
For further information consult an eye care ophthalmologist online --> https://www.icliniq.com/ask-a-doctor-online/eye-care-ophthalmologist
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