Eye Pressure: Expert Answers to Common Concerns

Q: Eye Pressure: Expert Answers to Common Concerns

Hello, Dr. Gao： 1. Regarding the eye drop "EYEHELP EYE DROPS 0.01% (containing neostigmine methylsulfate 0.1mg)," thank you for providing the medication information leaflet. I have understood its effects and side effects. May I ask if this eye drop contains "st

Follow-up inquiry #155163 regarding intraocular pressure issues?

Dear Dr.
Gao,
Thank you very much for your detailed response to my inquiry regarding the intraocular pressure issue in "#155163 Eye Pressure Consultation." You are truly a patient and professional doctor, and I am grateful for your efforts in alleviating the concerns and stress of many ophthalmology patients.
This is a blessing for us, and I sincerely appreciate your help.
Following your response to my previous inquiry in "#155163 Eye Pressure Consultation," I have a clearer understanding of most of the issues.
However, I would like to seek further clarification on a few points:
1.
Regarding the eye drop "EYEHELP EYE DROPS 0.01% (containing neostigmine methylsulfate 0.1mg)," I appreciate the information you provided about the medication.
I understand its effects and side effects.
Could you please clarify if this eye drop contains any "steroids"? Additionally, I found information stating that steroid-containing eye drops can increase intraocular pressure and potentially induce glaucoma (depending on individual constitution).
Could you please clarify this?
2.
Concerning insufficient glasses prescription, you mentioned that it "should not" cause an increase in intraocular pressure.
However, I am curious whether an inadequate prescription could lead to eye fatigue when looking at objects.
Wouldn't eye fatigue contribute to an increase in intraocular pressure? I would appreciate your clarification on this matter.
3.
Regarding the fundus examination, you stated that "the fundus examination can also assess the morphology of the optic nerve (the size of the optic nerve head cupping)." You did not mention any issues, which I interpret as no problems being present.
Does this mean that as long as a patient undergoes dilation for a fundus examination, the examining physician will also "simultaneously" check the optic nerve, in addition to examining the vitreous, retina, and macula? Or is it the case that this examination is not guaranteed unless specifically requested by the patient?
4.
My right eye's intraocular pressure reading is 22 mmHg.
You suggested, "just observe and have regular check-ups." Does this imply that this value (22 mmHg) is still within a normal range and poses no significant risk to the eye?
5.
Lastly, could you please explain what subjective symptoms a patient might experience when intraocular pressure rises sufficiently to induce glaucoma?
Thank you again, Dr.
Gao.

Axiang, 30~39 year old female. Ask Date: 2020/04/16

Dr. Gao Pilin reply Ophthalmology

Hello, Dr.
Gao:
1.
Regarding the eye drop "EYEHELP EYE DROPS 0.01% (containing neostigmine methylsulfate 0.1mg)," thank you for providing the medication information leaflet.
I have understood its effects and side effects.
May I ask if this eye drop contains "steroids"? Additionally, I found information stating that steroid-containing eye drops, if used excessively, can lead to increased intraocular pressure and potentially induce glaucoma (depending on individual constitution).
Please clarify, Dr.
Gao.
It does not contain steroids, so there is no need for concern.
2.
Concerning insufficient glasses prescription, Dr.
Gao replied that it "should not" cause an increase in intraocular pressure.
However, I am curious whether an inadequate prescription could lead to eye fatigue when viewing objects? And does eye fatigue not contribute to increased intraocular pressure? Please clarify, Dr.
Gao.
If it is myopia, an insufficient prescription means unclear vision, while an excessive prescription can lead to fatigue.
3.
Regarding the fundus examination, Dr.
Gao mentioned that "the fundus examination can also assess the morphology of the optic nerve (the size of the optic disc cupping)." He did not mention any issues, which I interpret to mean that as long as the patient undergoes dilation for the fundus examination, the examining physician will also "simultaneously" check the optic nerve, in addition to examining the vitreous, retina, and macula, under normal circumstances? Or is it not guaranteed, and the patient must "specifically request" the optic nerve examination? It should all be within the same scope and should be checked.
4.
My right eye's intraocular pressure is 22 mmHg.
Dr.
Gao suggested, "just observe and have regular check-ups." Does this imply that this value (22 mmHg) is still within a normal range? And does it pose no harm to the eyes? It is necessary to measure multiple times and refer to the morphology of the optic nerve.
21 mmHg is an average value, but some may be higher and some lower, so further examinations are needed for reference.
However, it will not cause harm in the short term.
5.
I would like to ask Dr.
Gao, when intraocular pressure rises sufficiently to induce glaucoma, what subjective symptoms will the patient definitely experience? Elevated intraocular pressure is a symptom, while glaucoma indicates permanent damage to the optic nerve.
Elevated intraocular pressure can cause eye discomfort, blurred vision, headaches, nausea, and vomiting.
Prolonged high intraocular pressure can lead to glaucoma.
Taiwan E-Hospital Puzi Hospital Ophthalmology: Monday, Tuesday, Thursday, and 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 references; it is necessary to seek medical care at a healthcare facility.
I hope to have the opportunity to serve you.
Dr.
Gao Pi-Lin

Reply Date: 2020/04/16

More Info

Hello, and thank you for your thoughtful questions regarding eye pressure and its implications. It's great to see you taking an active interest in your eye health, and I'm happy to provide further clarification on your concerns.

1. EYEHELP EYE DROPS and Steroids: The eye drops you mentioned, EYEHELP EYE DROPS, contain neostigmine methylsulfate, which is not a steroid. Neostigmine is a medication that primarily works as a cholinesterase inhibitor, which can help alleviate symptoms of eye fatigue by enhancing the action of acetylcholine, a neurotransmitter. Steroid eye drops, on the other hand, can indeed raise intraocular pressure (IOP) and potentially lead to glaucoma if used excessively. It's important to differentiate between these two types of medications, as their effects on eye pressure are quite different.

2. Eyeglass Prescription and Eye Fatigue: You are correct that an inadequate eyeglass prescription can lead to visual discomfort and fatigue. When your eyes are straining to focus due to incorrect lens power, it can cause fatigue, which may indirectly contribute to elevated eye pressure. However, while eye fatigue can be associated with temporary increases in IOP, it is not a direct cause of chronic elevated eye pressure or glaucoma. Regular eye exams and appropriate prescriptions are essential for maintaining eye health.

3. Eye Examination and Optic Nerve Assessment: During a comprehensive eye examination, especially when dilation is performed, the optic nerve is typically assessed as part of the overall evaluation of the retina and surrounding structures. However, the extent of this examination can vary based on the clinician's judgment and the patient's specific concerns. While most eye care professionals will evaluate the optic nerve during a routine eye exam, if you have specific concerns about your optic nerve health, it is advisable to mention this to your eye doctor to ensure it is thoroughly assessed.

4. Understanding Your Eye Pressure Reading: An eye pressure reading of 22 mmHg is considered to be on the higher end of the normal range, which typically caps at around 21 mmHg. However, it is essential to consider individual variability and other factors such as corneal thickness and overall eye health. Your doctor’s recommendation to observe and have regular follow-ups is prudent, as it allows for monitoring any changes over time without immediate intervention unless necessary.

5. Symptoms of Elevated Eye Pressure: Elevated eye pressure does not always present with noticeable symptoms. However, when IOP rises significantly, it can lead to conditions such as acute glaucoma, which may manifest as severe eye pain, headache, nausea, vomiting, blurred vision, and seeing halos around lights. It is crucial to be aware of these symptoms and seek immediate medical attention if they occur, as they can indicate a serious condition requiring prompt treatment.

In conclusion, maintaining regular eye examinations and being proactive about any changes in your vision or eye comfort is key to preserving your eye health. If you have further questions or concerns, do not hesitate to reach out to your eye care provider for personalized advice and management. Thank you for your engagement, and I wish you the best in your eye health journey!

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