Elevated Eye Pressure: Questions and Insights for Patients

Q: Elevated Eye Pressure: Questions and Insights for Patients

Hello, Ah-Xiang：<br>1. <br>What part of the eye is primarily examined to determine if a person can use mydriatic agents? The size of the anterior chamber angle is assessed; if the angle is open, the use of mydriatic agents is less likely to cause an increase in intraocular pressu

Consultation for intraocular pressure issues?

Dear Dr.
Gao,
Hello, I am Ah Xiang, who previously asked you some questions.
I sincerely appreciate your responses to my inquiries.
Following your advice, I visited an ophthalmology clinic yesterday for a dilated fundus examination.
It was confirmed that my floaters and flashes of light are due to age-related changes in my eyes and are not serious.
However, during the eye pressure check before the dilation, it was noted that my right eye had slightly elevated intraocular pressure at 22 mmHg, while my left eye was within the normal range at 21 mmHg.
Therefore, after the examining physician checked my eyes and confirmed the situation, I was allowed to use the dilating drops for the fundus examination.
I have the following questions for you (I apologize for the number of questions):
1.
After my right eye's intraocular pressure was found to be slightly elevated, the examining physician used an instrument to check my eyes before stating that I could use the dilating drops.
Could you please explain what specific areas of the eye this examination focuses on to determine if I can use the dilating drops?
2.
Regarding my slightly elevated eye pressure, the examining physician mentioned it might be due to eye fatigue and prescribed "EYEHELP EYE DROPS 0.01% (containing neostigmine methylsulfate 0.1 mg)." Can eye fatigue indeed lead to increased intraocular pressure? Additionally, does this eye drop have any effect on lowering eye pressure? Are there any side effects associated with it?
3.
If my eyeglass prescription is insufficient, could this cause an increase in intraocular pressure?
4.
Currently, I am experiencing a dull pain at the upper edge of my right eye, which seems to extend to the area near my right temple.
Could this be a symptom of elevated intraocular pressure?
5.
When I was measured for intraocular pressure using a pneumatic tonometer, I flinched and closed my eyes due to the sudden puff of air.
Would this action cause an increase in intraocular pressure?
6.
During my dilated examination, the nurse only administered the dilating drops once, while other patients received them twice.
Would receiving only one dose of the dilating drops affect the results of the fundus examination? What is the difference between receiving one versus two doses of the dilating drops?
7.
Does a standard fundus examination include an assessment of the optic nerve? After my examination, the physician mentioned that my vitreous and retina were fine but did not address the optic nerve.
Was the optic nerve assessed but found to be normal and thus not mentioned, or was it not examined at all?
8.
Given that my right eye's intraocular pressure is 22 mmHg, what would you recommend as the best course of action? (e.g., should I actively follow up for pressure measurements or just observe and have regular check-ups?)
Thank you very much, Dr.
Gao.

Axiang, 30~39 year old female. Ask Date: 2020/04/15

Dr. Gao Pilin reply Ophthalmology

Hello, Ah-Xiang:
1.
What part of the eye is primarily examined to determine if a person can use mydriatic agents? The size of the anterior chamber angle is assessed; if the angle is open, the use of mydriatic agents is less likely to cause an increase in intraocular pressure.
2.
Can eye fatigue lead to an increase in intraocular pressure? Yes, it can.
Additionally, the eye drops in question seem to be used for alleviating eye fatigue; do they have any effect on lowering intraocular pressure? Also, are there any side effects? They do not have a pressure-lowering effect.
For effects and side effects, please refer to: https://bit.ly/3coob4X.
3.
If the prescription glasses are insufficient, can that cause an increase in intraocular pressure? It should not.
4.
Currently, I have some dull pain at the upper edge of my right eye, and the discomfort seems to extend to the area near my right temple.
Dr.
Gao, could this be a symptom of elevated intraocular pressure? It should not be; with an intraocular pressure of around twenty, you should not feel anything.
The dull pain may be due to fatigue.
5.
When I was measured for intraocular pressure using a pneumatic tonometer, I slightly tensed up and closed my eyes due to the sudden puff of air.
Dr.
Gao, could this action cause an increase in intraocular pressure? It is possible, so it is advisable to repeat the measurement a few times; with practice, the readings may be lower.
6.
During my dilated eye exam, the nurse only administered the mydriatic agent once; however, other patients received it twice.
Dr.
Gao, will having only one dose of the mydriatic agent affect the results of the fundus examination? Also, what is the difference between one and two doses of the mydriatic agent? As long as the pupil is sufficiently dilated, the number of doses does not matter.
Some people respond quickly, while others respond slowly.
7.
Dr.
Gao, the general fundus examination did not mention the optic nerve.
Does this mean that the optic nerve was examined but not included in the report because there were no issues? After my fundus examination, the examining physician stated that there were no problems with my vitreous body or retina, but did not mention the optic nerve; was it not examined? The fundus examination can also assess the morphology of the optic nerve (the size of the optic disc cupping).
If it was not mentioned, it should indicate that there are no issues.
8.
Regarding my right eye's intraocular pressure of 22 mmHg, Dr.
Gao, what would be the best course of action for me? (e.g., actively follow up for pressure measurements or just observe and have regular check-ups) It is best to observe and have regular check-ups.

Taiwan E-Hospital Puzi Hospital Ophthalmology: Monday, Tuesday, Thursday, Friday mornings from 8:00 AM to 12:00 PM; Wednesday afternoons from 2:00 PM to 4:30 PM.
Online responses can only serve as a reference; it is necessary to seek medical attention at a healthcare facility.
I hope to have the opportunity to serve you.
Dr.
Gao Pi-Lin

Reply Date: 2020/04/15

More Info

Hello, Ah Xiang. Thank you for your detailed questions and for following up on your previous inquiries. It's great to hear that your recent eye examination confirmed that your floaters and flashes are related to age-related changes and are not a cause for concern. Let's address your questions regarding elevated eye pressure and related symptoms.

1. What does the eye examination check before dilating the pupils?
Before administering dilating drops, the eye doctor typically examines the anterior segment of the eye, including the cornea, lens, and the anterior chamber. They may also assess the optic nerve head (the point where the optic nerve enters the eye) and check for signs of any abnormalities that could contraindicate dilation. This is crucial because dilation can increase intraocular pressure (IOP) in certain conditions, such as narrow-angle glaucoma.

2. Can eye fatigue lead to elevated eye pressure?
Yes, eye fatigue can contribute to temporary increases in eye pressure. When the eyes are strained, such as from prolonged screen time or focusing on near objects, the muscles around the eyes can become tense, potentially affecting the drainage of aqueous humor (the fluid in the eye) and leading to elevated IOP. The eye drops you mentioned, EYEHELP EYE DROPS, contain neostigmine methylsulfate, which is primarily used to alleviate symptoms of eye fatigue and does not have a direct effect on lowering eye pressure. However, it’s essential to monitor for any side effects, which can include blurred vision or discomfort.

3. Does insufficient glasses prescription contribute to elevated eye pressure?
While an inadequate glasses prescription can lead to visual discomfort and fatigue, it is not directly linked to elevated eye pressure. However, if you are straining to see clearly, this can cause temporary discomfort and may indirectly affect your perception of pressure in the eyes.

4. Is the dull pain near the temple related to elevated eye pressure?
The sensation of dull pain around the eye and extending to the temple can be associated with various conditions, including tension headaches or eye strain. While elevated IOP can cause discomfort, it typically presents with more acute symptoms, such as severe pain, blurred vision, nausea, or vomiting, especially in cases of acute glaucoma. It’s advisable to monitor this symptom and discuss it with your eye doctor if it persists.

5. Does closing your eyes during the eye pressure test affect the measurement?
Closing your eyes during the air puff test (non-contact tonometry) may lead to an inaccurate reading, as the test relies on the cornea's response to the air puff. However, it is unlikely to cause a significant increase in actual eye pressure. If you are concerned about the accuracy of the measurement, it may be worth discussing with your doctor.

6. Is one drop of dilating agent sufficient for an accurate examination?
Typically, one drop of a dilating agent is sufficient for most patients, but some may require additional drops for optimal dilation, especially if they have darker irises or if the initial response is inadequate. The difference between one and two drops generally lies in the extent of dilation achieved, which can affect the thoroughness of the examination.

7. Does a standard eye exam include checks for the optic nerve?
Yes, a comprehensive eye exam usually includes an assessment of the optic nerve. This can be done through direct observation during the fundoscopic examination, where the doctor looks for signs of optic nerve damage or abnormalities. If your doctor did not mention the optic nerve specifically, it may have been assessed as part of the overall examination.

8. What should be the next steps regarding your eye pressure of 22 mmHg?
An eye pressure reading of 22 mmHg is slightly above the normal range (generally considered to be 10-21 mmHg). Given this reading, it is advisable to follow your doctor's recommendation for regular monitoring. This may involve periodic checks of your eye pressure and a comprehensive evaluation of your optic nerve to ensure there are no signs of glaucoma or other issues. If you experience any new symptoms or if the pressure increases, you should seek an earlier appointment.

In summary, while your current eye pressure is slightly elevated, it is essential to continue monitoring and follow your doctor's advice. Regular eye exams and being aware of any changes in your symptoms are crucial for maintaining your eye health. If you have any further concerns or symptoms, do not hesitate to reach out to your eye care provider. Thank you for your questions, and I wish you the best in your eye health journey!

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