Managing High Eye Pressure and Dry Eyes: Finding the Right Treatment

Q: Managing High Eye Pressure and Dry Eyes: Finding the Right Treatment

Hello： If your physician has a different diagnosis regarding glaucoma and you want to clarify whether you truly have glaucoma, it is recommended that you visit a large hospital with a glaucoma specialty for a thorough examination. <br>It is best to have a glaucoma specialist eval

High intraocular pressure + dry eye syndrome

I have been seeing a doctor for a year regarding my eye condition.
The medications prescribed to me include: 1.
Tears Naturale 15ml 2.
Medison eye drops 0.01% 3.
Izba (Travatan) 0.003% 2.5ml/bottle 4.
Duratears artificial tear ointment (to be used at bedtime) 5.
Alercet eye drops (the doctor said to use it if I experience itching) 6.
Out-of-pocket Cationorm single-dose artificial tears.
My intraocular pressure (IOP) has consistently ranged from 19 to 23 mmHg.
The doctor mentioned that I do not have glaucoma, but I should keep my IOP below 20 mmHg, so I need to continuously lower my IOP.
The doctor prescribed me medication to lower my IOP to be taken every night before bed.
I also have asthma, which means some IOP-lowering medications are not suitable for me.
I have been using these medications for over a year.
I do not feel any symptoms when my IOP is high, but my dry eye symptoms have not improved.
Last week, I consulted another doctor who advised me to stop using all the medications prescribed by the first doctor, except for the out-of-pocket artificial tears, as they were making my dry eyes worse.
After conducting an examination, he told me that I actually do not need to use IOP-lowering medications.
He explained that some people naturally have higher IOP and do not require treatment.
He also noted that my upper and lower eyelids were very red and in a state of inflammation, indicating meibomian gland dysfunction (oil-deficient dry eye).
He prescribed: 1.
Vidisic Gel 2.
Hylo-Care eye drops 0.2 mg/mg 5ml/bottle 3.
Out-of-pocket Urisol moisturizing single-dose eye drops.

Since I also have to take care of my child, who often wakes up crying at night, I frequently cannot sleep through the night.
After using the new medications for a week, I have noticed that my eyes feel very swollen at night, which feels like high IOP.
However, when I look at the ceiling light, I do not see rainbow glare, nor do I have headaches.
Given my situation, should I return to the first hospital or continue with the second one? I have been seeing the first hospital for over a year, but my dry eye symptoms have not significantly improved.
The second hospital claims that the medications from the first hospital are not suitable for me.
After using the first hospital's medications, I would often wake up with a lot of yellow eye discharge, while with the second hospital's medications, there is significantly less discharge.
If my child wakes up multiple times during the night, my IOP the next morning is usually between 20-21 mmHg, peaking at 23 mmHg, and my eyes feel particularly sore and dry.
I understand that I can only manage my condition with eye drops long-term, so I genuinely want to find a medication that is truly suitable for my issues.

Xiao Mei, 30~39 year old female. Ask Date: 2021/08/26

Dr. Gao Pilin reply Ophthalmology

Hello: If your physician has a different diagnosis regarding glaucoma and you want to clarify whether you truly have glaucoma, it is recommended that you visit a large hospital with a glaucoma specialty for a thorough examination.
It is best to have a glaucoma specialist evaluate your medication.
As for the previous medication issues, individual symptoms and constitutions can vary, which may lead to different reactions.

Reply Date: 2021/08/26

More Info

Managing high eye pressure and dry eyes can be a complex issue, especially when you have received conflicting advice from different healthcare providers. Your situation involves both elevated intraocular pressure (IOP) and symptoms of dry eye, which can significantly impact your quality of life.
Firstly, it’s important to understand that elevated eye pressure does not automatically indicate glaucoma, especially if your eye doctor has ruled it out. The normal range for IOP is typically between 10 and 21 mmHg, but some individuals may naturally have higher pressures without any adverse effects on their optic nerve or vision. Your doctor’s assessment that you are not experiencing glaucoma is reassuring, but it is essential to monitor your eye pressure regularly.

The medications prescribed to you, including artificial tears and various eye drops, aim to manage both your dry eye symptoms and your eye pressure. However, it seems that the first set of medications did not improve your dry eye condition and may have contributed to your discomfort. The second doctor’s recommendation to discontinue most of the previous medications, except for the artificial tears, suggests that they may have been exacerbating your dry eye symptoms.
Dry eye syndrome can be caused by a variety of factors, including environmental conditions, prolonged screen time, and certain medications. In your case, the diagnosis of "meibomian gland dysfunction" (MGD), which is a common cause of evaporative dry eye, indicates that your eyes may not be producing enough oil to keep the tear film stable. This could explain the redness and inflammation of your eyelids, as well as the yellow discharge you experienced with the first set of medications.

Regarding your concerns about feeling pressure in your eyes and fluctuating eye pressure readings, it is essential to consider that stress, fatigue, and lack of sleep (especially from caring for a child) can contribute to eye discomfort and may temporarily elevate IOP. The fact that you do not experience visual disturbances or headaches is a positive sign, as these symptoms can indicate more severe conditions like acute glaucoma.

Given the conflicting advice from the two doctors, it may be beneficial to seek a third opinion, preferably from a specialist in glaucoma or a comprehensive eye care center. A thorough examination, including visual field tests and imaging of the optic nerve, can provide more insight into your eye health and help determine whether ongoing treatment for eye pressure is necessary.

In the meantime, consider implementing some lifestyle changes to help manage your symptoms. Regular breaks from screens (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds), using a humidifier in your home, and ensuring you stay hydrated can all help alleviate dry eye symptoms. Additionally, practicing good eyelid hygiene, such as warm compresses and eyelid scrubs, can help reduce inflammation and improve meibomian gland function.

In summary, while managing high eye pressure and dry eyes can be challenging, it is crucial to work closely with your healthcare providers to find a treatment plan that works for you. Regular follow-ups and open communication about your symptoms will help ensure that you receive the best care possible.

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