| Medications |
Question: Can some antidepressants cause glaucoma?
Answer:
Most do not, but a few may dilate the pupil which could increase the chances of angle-closure glaucoma.
Dr. Rick Wilson
October 17, 2007
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Question: Can glaucoma drops cause blepharitis?
Answer:
Yes. They are irritating to the tear film and ocular surface and to the eyelids.
Dr. Michael James Pro
May 2, 2007
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Question: I have been on Cosopt for several years and it is keeping my pressures low. However, recently I have passed out four separate times due to low blood pressure and heart rate. Since Cosopt is the only medication I am using, could it be causing this?
Answer:
The timolol in Cosopt often slows the heart rate. This effect is supposed to wane after a few months as the body adjusts. It certainly seems appropriate to speak to your doctor about changing your medication to another combination without a beta-blocker. Passing out means your blood pressure is not adequate to give your brain the oxygen and nutrients it needs. Your eye is also not getting adequate blood supply during those episodes. Staying on the Cosopt could present a risk of hitting your head if you pass out, and too low a blood pressure also carries risks. As a general rule, the same effect as from Cosopt may be obtained by using a prostaglandin, if your angle is mostly open, or a topical carbonic anhydrase inhibitor and Alphagan, both to be taken twice a day, 10 minutes apart, if your angle is partially closed.
Dr. Rick Wilson
February 7, 2007
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Question: Can Neurontin affect my vision?
Answer:
Large doses of Neurontin can cause blurred vision or even double vision.
Dr. Rick Wilson
December 6, 2006
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Question: Can Cosopt be used three times a day?
Answer:
Cosopt should be used twice a day, about 12 hours apart. The trouble with using Cosopt more than twice a day is that the beta-blocker component may be overdosed and cause side effects like fatigue.
Dr. Michael James Pro
November 15, 2006
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Question: I have just started Travatan and my eyes are very bloodshot. How long should I wait to see if this improves?
Answer:
I would give the Travatan two weeks before judging the amount of redness in your eyes and whether it is tolerable for the long run. If after two weeks the redness is not tolerable, I would try Xalatan, which usually causes less redness but similar IOP-lowering.
Dr. Rick Wilson
November 1, 2006
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Question: Lots of medications have warnings stating that they should not be taken by glaucoma patients. Are there certain medications that definitely should not be taken either by glaucoma patients or by glaucoma suspects?
Answer:
There is a problem with these warnings that we have touched on numerous times in our chats. The warnings are meant for patients with occludable angles, those that are subject to angle closure. Most of the patients who know about their narrow angles have had an iridectomy, so the warning does not pertain to them any more. Those who don't know they have a narrow angle won't know to heed the warning. So the warning mainly scares the patients with open angle glaucoma, those who actually have no worries with any of the drugs with the warnings except those drugs containing a steroid. Steroids, both oral and topical, can cause IOP rises in all types of glaucoma.
Dr. Rick Wilson
October 18, 2006
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Question: Can a glaucoma patient who is taking eyedrops wear contact lenses?
Answer:
Generally, yes. I have many patients use lenses with no problem. I would recommend using a daily-wear lens, cleaning and caring for it well, and not sleeping with the lenses in.
Dr. Elliot Werner
June 7, 2006
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Question: Do those patients whose IOP's are not lowered by several glaucoma eyedrops tend to be resistant to all such eyedrops?
Answer:
Some patients do not respond to one or two medications but do respond to others. Some patients don't seem to respond to any medication. That's what makes glaucoma treatment so much trial and error.
Dr. Elliot Werner
June 7, 2006
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Question: Why is it recommended that prostaglandin drops be taken at night?
Answer:
Because they dilate the vessels on the surface of the eye. It is cosmetically more acceptable to have a red eye while you sleep, rather than all morning.
Dr. Rick Wilson
February 16, 2005
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Question: Does a prostaglandin have a permanent affect on the eye?
Answer:
The changes that are made in the ciliary body muscle take at least 6 weeks to revert to normal. The only permanent change we know of is the change in the color of the iris.
Dr. Rick Wilson
February 16, 2005
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Question: Is there a correlation between Topomax use and glaucoma?
Answer:
When Topomax usage results in glaucoma, there is a marked blurring of vision and angle closure. If you have not had any change in vision, it is unlikely the glaucoma is the result of Topomax.
Dr. Rick Wilson
April 06, 2005
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Question: Sometimes after using glaucoma drops, my eyes will burn. On other occasions it feels like there is a large grain of sand in my eye. Is this usual?
Answer:
If your eye is on the dry side, this is common. Almost any drop, even many artificial tears, will produce a burning sensation in an eye that has tiny dry (bare) spots on its surface.
Dr. Rick Wilson
April 20, 2005
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Question: When the cap on a bottle is removed to instill drops, should the cap be laid on its side or upright?
Answer:
Probably upright, on the flat bottom, since the lip of the cap doesn't contact the dropper tip. That prevents dust and other stuff from getting in the cap.
Dr. Elliot Werner
March 1, 2006
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Question: I have used several different glaucoma drops, and they all tend to form a bubble that bursts and drips down the nozzle. How can I prevent this?
Answer:
The bubble results from air in the bottle. Try holding the bottle upside down with the cap on for a moment before putting the drop in the eye. I have had conversations with drug manufacturers and tell them that a dropper bottle is a terrible way to deliver medication. An aerosol or spray of some sort would be much better.
Dr. Elliot Werner
March 1, 2006
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Question: Does the danger of contamination increase the longer the bottle is used?
Answer:
If you touch the bottle to your eyelid, yes, but the preservatives are pretty good at keeping the bacteria count down.
Dr. Elliot Werner
March 1, 2006
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Question: I use a bottle of timolol for four months or more, as I am on just one drop once a day in one eye. Is this safe?
Answer:
Timolol is a pretty stable substance and usually lasts a long time.
Dr. Elliot Werner
March 1, 2006
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Question: Once a bottle is opened, should it still be refrigerated?
Answer:
That's not necessary, unless the manufacturer says it is. It's important to protect the drops from excessive heat. Don't leave the bottle near a heater in the house, or in the car in summer.
Dr. Elliot Werner
March 1, 2006
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Question: How long is it safe to use medication from a single bottle? Isn't three months too long?
Answer:
In the USA, the FDA controls these things pretty closely and tells the manufacturers how long they can say their drugs last and what size bottles they can put them in. They will limit the size of the bottle for drugs that have a short shelf life, such as Xalatan. All patients can do is have faith in the FDA that there is evidence the drug will last three months in that bottle. Look at the expiration date on the bottle. Unopened bottles can be kept in the refrigerator to help preserve the drops.
Dr. Elliot Werner
March 1, 2006
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Question: Can Lumigan make arthritis worse?
Answer:
Lumigan, like the other prostaglandins, can aggravate arthritis as a side effect.
Dr. Elliot Werner
September 7, 2005
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Question: What medications are the most common causes of eye redness or irritation in glaucoma?
Answer:
Brimonidine [Alphagan] is far and away the topical medication that causes the most allergy, i.e., redness and discomfort. Xalatan causes a dilation of the vessels on the surface of the eyeball that leaves the eyes red, but usually without much in the way of symptoms. Travatan causes more redness, and Lumigan causes by far the most redness.
Dr. Rick Wilson
September 14, 2005
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Question: Can hypertension medications, specifically ACE inhibitors, raise intraocular pressure?
Answer:
Beta blockers lower eye pressure. Calcium channel blockers may improve circulation in some cases of normal-tension glaucoma. Most of the other antihypertensives have little effect on eye pressure.
Dr. Rick Wilson
February 16, 2005
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Question: Is there anything I can to reduce the stinging effect of my drops?
Answer:
We've talked about taking a tablespoon of flaxseed oil every day by mouth or two tablespoons of ground flax seed. That will improve your tears over several months of use. Taking artificial tears like Systane every few hours during the day will help to lubricate the cornea, so you will have less irritation with drops and in general.
Dr. Rick Wilson
February 16, 2005 |
Question: Since Xalatan, like Lumigan, is a prostaglandin, does it also tend to give people flu-like symptoms? Can Xalatan cause depression? What glaucoma eyedrop produces the fewest known CNS (central nervous system) and flu-like side effects?
Answer:
Lumigan is six times as strong a solution as Xalatan, so it would be expected to give a higher blood level and more symptoms than Xalatan. Xalatan can also cause flu-like symptoms, but the frequency of causing serious symptoms should be less. Covering the tear duct and keeping the eye closed for three minutes after instilling the drops greatly lowers the amount of medicine that gets into the body.
Dr. Rick Wilson
February 16, 2005 |
Question: Do glaucoma drops such as Lumigan increase the risk of cataracts?
Answer:
Not that we know. Steroids and very strong miotics like phospholine iodide can cause cataracts.
Dr. Rick Wilson
February 16, 2005 |
Question: Does smoking pot help glaucoma?
Answer:
It lowers the intraocular pressure for a short time. Unfortunately, because of its brief duration of action, smoking pot does not seem to be near as effective as the drops we have.
Dr. Rick Wilson
October 5, 2005
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Question: What is atropine used for?
Answer:
Atropine paralyzes the muscles in the eye, and increases the barrier in the vessel walls that prevents serum proteins from leaking into the eye. It is used often post-operatively to limit inflammation and to deepen the front chamber of the eye.
Dr. Rick Wilson
October 26, 2005
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