Questions & Answers

Glaucoma does not cause a lump or tumor in the retina. However, some ocular tumors can be associated with “secondary glaucoma,” which means that the size or nature of the tumor is causing the glaucoma.

Thyroid disease can be associated with glaucoma, but the relationship between the two conditions is not well understood. Patients with thyroid-related eye disease (Graves’ ophthalmopathy) can develop glaucoma in relation to the compression of the eye and optic nerve by the enlarged extraocular muscles. This type of glaucoma is usually associated with increased eye pressure. In your case, the eye pressures are not markedly elevated, yet your doctors are indicating that there are signs of glaucoma. In many major studies, 30-50% of patients with glaucoma have pressures that are considered "normal."

You have stated two definite risk factors for having glaucoma: a family history of glaucoma and fluctuating eye pressure. It appears that several years ago, your doctor did not feel that you had developed signs of glaucoma. Namely, he determined that your true eye pressure was lower than 21 based on the fact that you have thick corneas, and that your optic nerve appeared healthy when he tested its structure and function. Corneal thickness does influence the accuracy of the measurement of intraocular pressure. Your most recent eye pressure reading of 13 with signs of glaucoma is concerning. Patients with glaucoma can have large fluctuations in the eye pressure. To make a diagnosis of glaucoma, detection of optic nerve dysfunction either with visual field testing or optic nerve head imaging is necessary. You should ask your doctor how he made the diagnosis of glaucoma. Obtaining another medical opinion from a board certified eye doctor is never a bad idea, and bringing old records to your appointment is vital to an accurate assessment of your eye health.

Regarding treatment, there are numerous classes of medications that are used to treat glaucoma. Commonly used medications include topical beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors, which can cause depression in a small number of patients. Other common medications such as prostaglandin analogs do not cause or worsen depression. Additional options include laser or incisional surgery. When you meet with your eye doctor to talk about your diagnosis, you can also discuss glaucoma treatment options and your concerns about their impact on depression.

Using your eyes for daily tasks including computer work, reading or driving, for example, does not cause worsening of glaucoma. Treatment of the glaucoma with medications or laser trabeculoplasty to lower the eye pressure is important to halt the progression of the disease.

Intermittent blurring of the vision can be caused by numerous factors. Dry eyes can definitely cause foggy vision and glare symptoms. The severity of the symptoms can vary daily and each eye can be impacted differently. Intermittent high eye pressures can cause swelling of the cornea, and can result in colored haloes. However, these high eye pressures are usually associated with pain and light sensitivity. Clouding of the lens capsule that surrounds her lens implant can also cause blurred vision, but this condition should be fairly constant and diagnosable by routine examination. Chronic steroid use can be associated with steroid-induced glaucoma, which would be detected clinically by elevated eye pressures and signs of optic nerve dysfunction. Your daughter's eye condition is complex, and a second opinion is never a bad idea. The majority of eye care providers accept patients with Medicaid insurance. EyeCare America, a program of the American Academy of Ophthalmology, can help you locate an eye doctor, if you would like to seek another opinion. Their number is 1-800-222-3937.

Your symptoms are very concerning. Transient loss of vision in one eye can be associated with poor cerebral blood flow and impending stroke (a condition known as amaurosis fugax). This type of transient vision loss is often described as a curtain or veil clouding the vision completely, and can happen to only one eye at a time. The glaucoma eye drops may improve blood supply to the optic nerve by lowering the eye pressure and allow the impaired blood circulation to better reach the optic nerve, which could possibly explain the improvement in your vision. You should speak to your eye doctor right away so that he/she can determine the nature of the transient vision loss. If it is determined that you are having transient ischemic attacks, you need evaluation immediately to reduce your risk for a major stroke.

Cold medicines such as Actifed and Sudafed can cause mild pupil dilation, which can affect eye pressure. Patients with very narrow angles or untreated angle-closure should not take cold medications, as they are at risk for an attack of acute angle-closure glaucoma. Patients who have treated narrow-angle glaucoma or open-angle glaucoma can take cold medicines safely. Your eye care provider should be able to advise you as to the safety of this medication class in your particular case.

Timolol has not been shown to cause pupillary dilation. Timolol is a topical beta-blocker that acts to reduce intraocular pressure, and is very commonly prescribed for the treatment of glaucoma. The size of your left pupil may be related to the prior retinal vein occlusion. Other causes of pupillary dilation include topical medications (dilating or cycloplegic eye drops), iris neovascularization, prior intraocular surgery, and others. Your eye doctor should be able to determine the cause of your pupillary asymmetry.