Ask an Expert about Glaucoma

Thank you for submitting your question. First, you should know that this happens to many of our patients at one time or another, so you are not alone. There may be two possible ways to interpret your question, so let me answer both.

If you squeeze the bottle hard enough that more than one drop comes out and a couple of drops get into your eye, there is no problem medically when this happens. The eye only holds so much fluid (tears, medications, etc.) at one time and if there is too much fluid in the eye, when you blink, it will push out the excess and you will feel it run down your cheek. The drawback is that if you put more than one drop in at a time and you are blinking out the extra, it is a waste of medication and it can cost you money because you will need to refill your medications more frequently. In these cases, sometimes we suggest having someone assist you in putting in the medication, if that is possible.

On the other hand, if you are supposed to take Combigan two times, and sometimes you put in an extra drop because you think that you previously forgot to put the correct number of drops in, that means that you might occasionally put in three drops of Combigan throughout the day instead of two. This is a slightly different issue. If it only happens once in a great while, there is a pretty good chance that nothing bad will happen. It is best to avoid doing this because there is a very small chance you could get some additional side effects from taking too much of the medication. It is similar to taking an extra dose of any oral medications that you might take. If you notice that you are taking extra drops, I would suggest using a tally system on a piece of paper. As soon as you put a drop in, put a mark on piece of paper that reminds you that you took the drop. If you forget, you can always go back and look at your tally sheet. I hope this helps, and I wish you the best of luck.

Thank you for your question. It sounds as though you have been followed for some time and have maintained good follow up with a glaucoma doctor. It is difficult to predict what course your glaucoma will take over time and the path for every individual is different. Because of this variability, it is important to see the eye doctor regularly. Once a thorough eye exam has been completed, eye doctors will often set a target or goal intraocular pressure. This was probably done by your first doctor and it took using Xalatan to get the pressure to that target. The question you should ask your doctor is whether they still think you have glaucoma and what the goal intraocular pressure is in your case. The other possibility is that you are considered a “glaucoma suspect” and the doctor thinks that you might be at risk of eventually developing glaucoma but may not yet have it. In these cases, different doctors have either more aggressive or more conservative treatment strategies. One doctor may start a medication almost as a preventative measure while others may wait and see if glaucoma ever develops before suggesting that a medication be started.

In general, if you have glaucoma, the only variable that we can change to slow or stop the progression of your glaucoma is the intraocular pressure. To achieve this goal, there are essentially three different tools that doctors can use to treat glaucoma: medicated eye drops, laser treatments, and surgical methods. Your doctor will follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see how your eyes respond. If the pressure is not reduced enough or your doctor ever notices advancement in your glaucoma, they will add more medications or use laser or surgery to help lower the intraocular pressure further. If the pressure is well below the goal intraocular pressure it is always possible to stop or reduce the medications in order to see if the medication is still needed. I would highly suggest that if you are reducing your medications that you make a plan for follow up visits to your eye doctor and keep all of your appointments. If you ever see any signs of progression, restart the medications immediately. I wish you the best of luck.

Thank you for your question. SLT should not cause neovascularization of the iris. Neovascularization (neo” meaning new and “vascular” meaning vessels) occurs when new blood vessels begin growing inside the eye. Typically, these new blood vessels grow in response to ischemia (a lack of oxygen to the tissues in the eye). Because enough oxygen is not getting to the tissue, the eye tries to get more blood (and hence more oxygen) to the eye by creating new blood vessels. Unfortunately, in many of these cases the new blood vessels are not healthy vessels and can cause bleeding in the eye. SLT is a laser that causes a restructuring of the trabecular meshwork that reduces the resistance of flow through its channels (and hence reduces intraocular pressure). In no way should the SLT laser treatment cause neovascularization. The most typical reasons for neovascularization are diabetes or ocular ischemic syndrome. If you are concerned about why the blood vessels began to grow, please ask your doctor for an explanation. I wish you the best of luck.

Thank you for your question. In all of my research, I could not find any evidence that sunscreen or any of its ingredients could cause glaucoma by penetrating the eye or trabecular meshwork. In general, I highly suggest keeping it out of your eye, if at all possible. From experience, I can tell you it stings and it will turn your eyes red! If you have had a glaucoma surgery, the irritation could cause the conjunctiva (the outer covering over the white sclera) to turn red. If that redness does not dissipate, you should see your ophthalmologist to make sure everything is okay. If you get some sunscreen in your eye, you can also use preservative free artificial tears to help wash it out. Finally, as a physician, I highly recommend that if you are out in the sun that you continue to use sunscreen to help prevent skin cancer. You can stop near your eyelids and simply wear sunglasses with UV protection if you are concerned about getting the sunscreen in your eyes. I wish you the best of luck.

Thank you for your question. Since it is difficult to ascertain the status of your eyes without examining you, I think the best approach would be to have your doctor explain why he is ordering the ultrasound test for glaucoma. But I can help you with some of your questions. Glaucoma affects peripheral vision first, so often patients do not notice any visual symptoms because one eye compensates for the other, and the decreased vision is in the peripheral regions of the visual field. Only when glaucoma becomes advanced does it affect central vision. It sounds like your optic nerves are healthy, though, and since glaucoma affects the optic nerve, it probably means that you do not have open-angle glaucoma. However, your doctor ordered an ultrasound test, and I wonder if he is concerned about narrow-angle glaucoma. In some patients with narrow angle configuration, doctors will recommend a laser procedure to prevent patients from having a narrow angle glaucoma attack. It does not actually mean that you have glaucoma, just that you have an angle anatomy that might put you at higher risk for having a narrow angle glaucoma attack. If your doctor is not able to provide you with answers to your questions, it is reasonable to get a second opinion. Good luck!

Thank you for your question. Although the pressure is already “normal” in normal-tension glaucoma, large clinical trials have shown that lowering eye pressure decreases the rate of glaucoma progression, even in normal-tension glaucoma. That being said, the patients in various studies have different characteristics, and as doctors, we cannot simply apply these study results to all of our patients. For example, without examining you, and getting to know you over time, it is difficult to discern whether 15 millimeters of mercury is an adequate pressure for you or whether it needs to go lower—this is where building your relationship with your doctor and getting good follow-up will help. Certainly, if you can tolerate the side effects of the medications, which you can read about in previous posts on this website, there is definite benefit in lowering the pressure. If you require surgery to reach your target pressure (which is different for each individual patient), you need to have a frank discussion with your doctor about the risks versus the benefits of surgery. I hope this helps answer your question.

I am glad to hear that your glaucoma is well-managed.  For your daughters, I would recommend a baseline evaluation by a glaucoma specialist.  As you know, glaucoma often manifests itself over time so it would be important to have baseline documentation of your daughters' eye pressures, optic nerves, and visual fields.  There is abundant research looking into optic nerve regeneration and neuroprotective agents.  So far, the only treatment we have is to lower the intraocular pressure, but in the future there is hope that we will be able to tackle glaucoma by protecting the optic nerve cells and/or stimulating their survival.  While it takes time for research in the laboratory to make it to clinical trials, you can see what glaucoma trials are ongoing by visiting the www.clinicaltrials.gov website and entering glaucoma in the search field. Clinicaltrials.gov is a database maintained by the National Institutes of Health that lists both government-sponsored and privately sponsored clinical trials conducted in the United States and around the world.  Please also view our glaucoma medical and research news updates. You can also sign up to receive these updates via email.

He suspected closed-angle glaucoma and told me that I needed an iridotomy right away. I had this procedure performed on October, 28, and I was then told to use Timilol in both eyes twice a day. I have not had any change in my morning eye attacks and he referred me to a glaucoma specialist. My pressure has come down (19 in my good eye and 20 in the eye that is blurry in morning), but I'm really freaked and nervous beyond belief. I feel unsteady on my feet and my blood pressure that is under control with Atenolol, spiked to 201/108 recently. It did not stay that high, but it never really got normal the rest of that day. My vision in the eye is not normal either and I have to wear glasses all of the time now. The doctor said my vision has not changed according to his eye test, but it does not seem that way to me. I really would appreciate it if you could give me some input as to what you might think is going on. I'm not living a normal life now and I'm having anxiety issues daily. Thank you for your time and hope to hear from you.

I am sorry to hear that you are having so much difficulty and that it is impacting your life so much. I would like to reassure you the best I can, but of course without examining you it is difficult to determine what exactly is happening. However, it sounds like you are receiving very good care. The symptoms you described can be consistent with angle-closure glaucoma, and you have undergone the necessary procedure. However, sometimes your angles can still stay “narrow” after iridotomies. It was not clear from your question whether you have seen the glaucoma specialist and what his/her opinion is regarding your angle anatomy. If they are still somewhat narrow, there are other conditions that may be causing your symptoms. The good news is that your eye pressure is under control and you should not worry as your doctors try to figure out why you are still having symptoms. Another possibility is that you may have a cornea condition that gives you the blurry vision in the mornings but improves as the morning progresses. Lastly, it is important to observe whether your symptoms are occurring only in the right eye versus both eyes, because this changes the possible diagnoses. I recommend that you seek out a glaucoma specialist if you have not already done so, and if you have, I would emphasize that your symptoms remain and to ask him/her to address your concerns. I wish you the best of luck!