High Eye Pressure and Eye Discomfort: Key Insights

Elevated intraocular pressure and eye discomfort?

Hello Doctor, on January 16th, I visited an ophthalmology clinic due to swelling and pain in my left eye (the symptoms had been present for about 3-4 days, but it wasn't a constant discomfort; it would occasionally occur a few times throughout the day, and the swelling and pain were not very severe).
The doctor diagnosed it as eye fatigue and noted that my intraocular pressure was slightly elevated (but did not specify the exact numbers, and I forgot to ask).
I was prescribed two types of eye drops, said to relax the muscles and relieve fatigue; I can't remember the names, but I recall one was red (it seemed to be called Scopolamine).
After using the drops for two weeks, I felt that the symptoms were still fluctuating, and sometimes I would experience pain (like someone was digging into my eyeball), but when there were no symptoms, it felt normal.
On February 6th, I went to another ophthalmologist for a check-up.
The doctor mentioned that my intraocular pressure was elevated (23 and 24, but did not specify which eye).
I explained my symptoms to the doctor, who also said it was due to eye fatigue.
After examination, the doctor confirmed that my optic nerve appeared normal and prescribed pressure-lowering eye drops (used twice daily) and protective eye drops (four times a day).
After two weeks of using these, I noticed some improvement in my symptoms, but I still experienced fluctuations, although the pain was less frequent; however, the "swelling" sensation occasionally persisted.
During a follow-up on February 18th to monitor my intraocular pressure, the doctor noted that it had decreased (18 and 19).
The doctor did not perform any additional tests, only reviewed the pressure readings, and provided some eye care advice (such as reducing screen time, applying warm compresses, massaging, and performing eye exercises).
I was prescribed two more bottles of eye drops (one was the same protective eye drop, four times a day; the other was a short-acting mydriatic to be used before bedtime).
Currently, my symptoms have improved somewhat, but the swelling sensation still occasionally occurs.
Based on the above symptom description, I have a few questions:
1.
The doctor prescribed pressure-lowering eye drops to reduce my intraocular pressure.
If I stop using the drops, will my pressure remain normal? I continued using the drops until the day of my follow-up, and I'm concerned that the drops might be the reason my pressure readings were normal.
2.
Since my intraocular pressure is now normal, why do I still occasionally feel swelling in my eyes? This symptom may not be related to the pressure; what other eye issues could I potentially have?
3.
Mydriatics are typically used for patients with myopia; will this help with the symptoms I described? The prescription only mentioned that it could potentially cause "elevated intraocular pressure," but I already have elevated pressure, so isn't that contradictory?
4.
I haven't started using the mydriatic yet because I still have some pressure-lowering drops left.
I plan to finish those before starting the mydriatic.
Regarding question 3, if it could raise my intraocular pressure, I'm worried it might conflict with the pressure-lowering drops.
How should I use the mydriatic? Can I use them together (pressure-lowering drops in the morning and evening, mydriatic at bedtime, and protective drops three times a day plus at bedtime), or should I stop the pressure-lowering drops and switch directly to the mydriatic?
5.
The doctor did not specify how long to use the last prescribed drops or if I need to return for another follow-up.
Should I complete the entire course of the drops? Additionally, how long do you recommend waiting before returning for a follow-up?
Other notes (I hope this helps clarify my situation): I work all day on a computer, and I know I am nearsighted, but it may not be severe.
I do not regularly wear glasses because, so far, I can manage daily activities (seeing far and near, using the computer, watching TV, reading, driving, etc.).
However, during my recent visit to the doctor, my vision was checked, and I was informed that I have some degree of myopia.
Thank you for your assistance, Doctor.

Mr. Chen, 30~39 year old female. Ask Date: 2020/02/21

Dr. Gao Pilin reply Ophthalmology

Hello Mr.
Chen,
1.
The doctor prescribed eye drops to lower intraocular pressure (IOP).
If the drops are discontinued, can the IOP remain normal? I have been using the drops until the day of my follow-up appointment, and I'm concerned that the drops are the reason my IOP readings are normal.
If the IOP is high, it usually requires continuous treatment and cannot be stopped.
2.
Since my IOP is normal, I still occasionally experience a feeling of pressure in my eyes.
This symptom may not be related to IOP.
What other eye issues could I be experiencing? The sensation of pressure and pain is likely not related to IOP, as your IOP was only slightly elevated, and you shouldn't feel much difference.
The most common cause of pressure and discomfort is eye strain.
3.
Mydriatic agents are intended for patients with myopia.
Would this help with the symptoms I described? The prescription only mentioned that it could potentially cause "increased IOP," but I am already using drops to lower my IOP, which seems contradictory.
Mydriatic agents help relax your eyes to see if they can alleviate the pressure and pain.
Only a small number of individuals experience increased IOP from mydriatic agents.
4.
I have not started using the mydriatic drops yet because I still have some of the IOP-lowering drops left.
I plan to finish those before starting the mydriatic drops.
Regarding question 3, if the mydriatic drops can cause increased IOP, I am concerned about a conflict with the IOP-lowering drops.
How should I use the mydriatic drops? Can they be used together (IOP-lowering drops in the morning and evening, mydriatic drops at bedtime, and eye care drops in the morning, noon, evening, and before bed)? Or should I stop the IOP-lowering drops and switch directly to the mydriatic drops? Please follow your doctor's instructions.
If you need to use different eye drops simultaneously, a ten-minute interval is sufficient.
5.
The last time I received the eye drops, the doctor did not specify how long I should use them or if I need to return for a follow-up.
Should I finish all the drops? Additionally, how long after that would you recommend I return for monitoring? You should return for a follow-up before finishing the drops.
Additional information (I hope this helps describe my condition): I typically use a computer all day at work.
I know I am nearsighted, but it may not be severe.
I do not regularly wear glasses because I can manage daily activities (seeing far and near, using a computer, watching TV, reading, driving, etc.) without issues.
However, during my recent visit to the doctor, my vision was checked, and I was informed that I have some degree of myopia.
Therefore, your eye pressure and discomfort are related to your prolonged computer use.
You can use the 20-20-20 rule: every 20 minutes of computer use, look away from the screen for 20 seconds and focus on something 20 feet (6 meters) away.
If you can blink 20 times during that time, even better.
Taiwan E-Hospital, Puzi Hospital, Ophthalmology Department:
Monday, Tuesday, Thursday, Friday: 8:00 AM – 12:00 PM
Wednesday: 2:00 PM – 4:30 PM
Online responses are for reference only; it is essential to seek medical attention at a healthcare facility if necessary.
I hope to have the opportunity to assist you.
Best regards,
Gao Pilin

Reply Date: 2020/02/21

More Info

Understanding high eye pressure and the associated discomfort can be a complex issue, especially for individuals with pre-existing conditions like myopia. Your symptoms, including the feeling of pressure and occasional pain in your eye, can be concerning, particularly when coupled with elevated eye pressure readings. Here’s a comprehensive breakdown of your questions and concerns.

1. Effect of Eye Drops on Eye Pressure: When you use eye drops to lower eye pressure, the effects can vary. If you stop using the drops, your eye pressure may rise again, especially if the underlying cause of the elevated pressure is not addressed. The drops work by either reducing the production of aqueous humor (the fluid in the eye) or increasing its outflow. If your eye pressure was controlled solely by the medication, it is likely that without it, the pressure could return to higher levels. Regular follow-ups with your eye doctor are essential to monitor this.

2. Persistent Pressure Sensation: The sensation of pressure in your eye, even when the eye pressure readings are normal, may not be directly related to the intraocular pressure itself. This discomfort could stem from several factors, including eye strain, dry eyes, or even tension in the eye muscles. Given your extensive computer use, eye fatigue is a plausible cause. Conditions like dry eye syndrome can also lead to a feeling of pressure or discomfort, as the eyes may not be adequately lubricated.

3. Use of Mydriatic Agents (Dilating Drops): Mydriatic agents are often used to facilitate a thorough examination of the retina and optic nerve. While they can cause temporary increases in eye pressure in some individuals, they are generally safe when used appropriately. If your doctor prescribed them, they likely deemed the benefits of the examination to outweigh the risks. It’s important to communicate any concerns about potential side effects with your healthcare provider.

4. Combining Medications: If you are concerned about using both the pressure-lowering drops and the dilating drops, it is best to consult your eye doctor. They can provide specific guidance on how to use these medications together. In many cases, it is safe to use them concurrently, but your doctor may have specific instructions based on your unique situation.

5. Completing the Medication Course: It is generally advisable to complete the prescribed course of medication unless instructed otherwise by your doctor. Stopping medication prematurely can lead to a resurgence of symptoms or complications. If your doctor did not specify a follow-up appointment, it would be prudent to schedule one in a few weeks to reassess your eye pressure and overall eye health.

In addition to these points, consider the following general tips for managing eye health, especially given your extensive computer use:
- Regular Breaks: Follow the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds. This can help reduce eye strain.

- Proper Lighting: Ensure your workspace is well-lit to minimize glare and strain on your eyes.

- Hydration and Humidification: Keep your eyes hydrated by drinking plenty of water and using a humidifier if necessary, especially in dry environments.

- Eye Exercises: Gentle eye exercises can help alleviate tension. Simple movements like rolling your eyes or focusing on near and far objects can be beneficial.

- Routine Eye Exams: Regular check-ups with your eye doctor are crucial for monitoring your eye health, especially with your history of high eye pressure and myopia.

In conclusion, while your symptoms may be concerning, they can often be managed effectively with appropriate care and lifestyle adjustments. Always communicate openly with your healthcare provider about your symptoms and any changes you experience. Your proactive approach to your eye health is commendable, and with the right management, you can maintain good vision and comfort.

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