Eye Irritation and Glaucoma: Symptoms and Diagnosis

The eyes feel very itchy and irritated, and there is continuous tearing?

Hello, Dr.
Tsai! I have two questions I would like to ask you.

First, I have been experiencing a very irritating sensation in my eyes lately.
Sometimes it occurs when I tear up, and other times it happens when I touch the corner of my eye where there is discharge.
Initially, I feel an itch for about 2 to 3 seconds, but then the irritation intensifies.
It's hard to describe the feeling, but it causes my eyes to water excessively, and I cannot open them.
If I try to open my eyes, the irritation worsens.
The only relief comes from keeping my eyes closed, and I have to wash them with water to completely resolve the situation.
Alternatively, I can only keep my eyes closed and wait for the symptoms to subside, which happens about once a day.
Therefore, I suspect there might be some inflammation or possibly dry eye syndrome.
However, I haven't experienced any dryness in my eyes so far, and I wouldn't know what that feels like.
My second question is that I recently visited a doctor who suspected I might have glaucoma because my intraocular pressure readings were slightly elevated.
Additionally, after shining a light with a small mirror, the doctor noted that my optic nerve appeared to be in poor condition, and I have high myopia, with my left eye at -9.00 and my right eye at -6.00.
I was later scheduled for a visual field test.
I initially thought that any defects would be more severe in my left eye, but surprisingly, it was my right eye, which has the better vision.
Is the visual field test sufficient for a complete diagnosis? During the test, I sometimes wondered if I was experiencing visual remnants, which made me hesitate to press the button.
If a definitive diagnosis of glaucoma is needed, are there any other tests that can be performed?

Mr. Lu, 20~29 year old female. Ask Date: 2018/01/16

Dr. Cai Wenyuan reply Ophthalmology

Hello, visual field testing is a subjective examination, and there can certainly be issues with accuracy.
The diagnosis of glaucoma is best determined by considering intraocular pressure, the cupping of the optic nerve head, and visual field testing together.
Wishing you safety and health.
Sincerely, Dr.
Wen-Yuan Tsai, Director of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2018/01/16

More Info

Hello! Thank you for your questions regarding eye irritation and the potential diagnosis of glaucoma. Let's break down your concerns into two parts: the symptoms of eye irritation and the implications of your glaucoma diagnosis.

Eye Irritation Symptoms
From your description, it sounds like you are experiencing significant discomfort in your eyes, characterized by a strong urge to tear up, itchiness, and an inability to keep your eyes open without exacerbating the irritation. This could potentially be due to several factors, including:
1. Allergic Reactions: Allergies to dust, pollen, or other environmental factors can cause itching and tearing. If you have been exposed to allergens, this could explain your symptoms.

2. Infection or Inflammation: Conditions such as conjunctivitis (pink eye) can lead to irritation, tearing, and discomfort. If you notice redness, discharge, or swelling, it may be worth consulting a healthcare professional.

3. Dry Eye Syndrome: Although you mentioned not feeling dryness, dry eye can sometimes present with excessive tearing as a reflex response to irritation. This condition occurs when your eyes do not produce enough tears or when the tears evaporate too quickly.

4. Foreign Body Sensation: If you have been touching your eyes or if there is debris in your eyes, this could lead to irritation and the symptoms you describe.
Given that your symptoms are frequent and disruptive, it would be advisable to consult an eye care professional. They can perform a thorough examination, including tests for dry eye and other potential conditions, to determine the underlying cause of your irritation.

Glaucoma Diagnosis
Regarding your concerns about glaucoma, it is important to understand that diagnosing this condition typically involves several tests, including:
1. Intraocular Pressure (IOP) Measurement: Elevated eye pressure can be a risk factor for glaucoma, but it is not definitive on its own.

2. Visual Field Testing: This test assesses your peripheral vision and can help identify any loss that may indicate glaucoma. It sounds like you have already undergone this test, but it can sometimes yield variable results based on patient cooperation and fatigue during the test.

3. Optic Nerve Examination: An eye care professional will look for changes in the optic nerve that may suggest glaucoma. This can include looking for cupping of the optic nerve head.

4. OCT (Optical Coherence Tomography): This imaging test provides detailed images of the optic nerve and can help detect early changes associated with glaucoma.

5. Pachymetry: This test measures the thickness of your cornea, which can also be a factor in glaucoma risk.

Your concern about the variability in your visual field test results is valid. Factors such as fatigue, anxiety, and even the lighting conditions during the test can affect outcomes. If you feel uncertain about the results, seeking a second opinion or repeating the tests after a short interval may provide clarity.

Conclusion
In summary, your eye irritation could stem from various causes, including allergies, infections, or dry eye syndrome. It is essential to consult an eye care professional for a thorough evaluation. Regarding glaucoma, while visual field testing is a critical component of diagnosis, it is not the sole determinant. A comprehensive approach involving multiple tests is necessary to confirm or rule out glaucoma. If you have concerns about your current diagnosis or treatment plan, do not hesitate to seek a second opinion for peace of mind. Your eye health is paramount, and addressing these issues promptly can help prevent further complications.

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