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Dr. James
Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience:  Eye Physician and Surgeon
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I had retenal detachment surgery in January this year owing

Resolved Question:

I had retenal detachment surgery in January this year owing to trauma with cilicon oil injected in my eye. i also have 8 year history of open angle glaucoma. i have been using cosopt and travatan in both eyes but after surgery i was given alphagan as an additional drop twicw daily only for the operated eye.

my eye pressure in the right (opretaed eye) is high and my surgeon is not ready to remove oil before February next year. My opthomologist insists that I must get the oil removed to save my eye from going totally blind because of high eye pressure. i dont know what to do . My eye surgeon has now given me additional drops 4 times a day for operated eye called PILOCAR 2%. I got operated in Karachi due to the emergency situaution but am a Canadian citizen working in Dubai.
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. James replied 3 years ago.
Chat Conversation Started
Dr. James :

Please Note:
JustAnswer is a public forum. Information provided is for educational purposes & does not establish a patient-physician relationship nor substitute for a personal consultation with a physician.

Dr. James :

Hello,

What are the measurements of your eye pressure?
What is you vision out of that eye?
When was the silicone oil initially placed?

Customer:

the operated eye has a presure of 28 and other eye is 20

Customer:

with the oprated eye i can see but very blurred vision not clear. i cant read with it but can drive with both eyes open

Customer:

the oil was initially placed on 21 January 2010

Customer:

additionally i have gone thru angioplasty with installation of 2 medicated stents so i was told can not stop taking aspirin till March next year

Customer:

hi doctor are u there?

Dr. James :

This is a difficult situation and not uncommon. Silicone oil is used in cases of retinal detachment in which the surgeon believes has a high chance of re-detachment, such as traumatic causes. A pressure of 28 is high, but it does not mean that the oil needs to come out.

If the pilocarpine brings the pressure down to a more normal level, then that may allow the oil to stay in longer. Each doctor has their own particular interest -- your ophthalmologist wants to preserve sight from the high pressure. Your retina surgeon is worried that if the silicone oil comes out too early, then you risk re-detachment which can also cause you to lose vision.


Dr. James :

Unfortunately, there is no clear cut answer for you. You may consider talking to another retina surgeon for a second opinion.

Dr. James :

You might also consider glaucoma laser to help lower the eye pressure.

Customer:

thats correct. is there worth monitoring presure at home with some home testing device such as proview

Customer:

what presure shall i aim at

Dr. James :

In some cases where the silicone oil has emulsified and clogging the drainage system of the eye, then silicone removal may be indicated. You doctor will need to perform a test called a gonioscopy to look for these emulsified oils.

Customer:

i did that and another retina specialist wanted the oil to be removed but would not take any responsibilty of redetachment

Dr. James :

I am not familiar with any home monitoring system of eye pressure.

Customer:

it is introduced by bausch and lomb calle proview. but i dont know how eefective it is

Dr. James :

Normal eye pressure is between 10-21 mmHg. The target pressure depends on the amount of nerve damage already pressure. If there is only moderate damage, then a goal is less than 21 is appropriate. If there is severe damage, then a pressure of less than 15 is more appropriate.

Customer:

otherwise how should i monitor the presure on day to day basis

Dr. James :

http://www.bausch.com/en_US/ecp/pharma/product/proview.aspx

Customer:

yes sir

Dr. James :

The device measures the pressure when the eyelid is closed. I am doubtful that this device can give very accurate information. In glaucoma, a few points in measurements is significant. Measurement through the eyelid has much more variability because of increase resistence of the eyelid tissue.

Customer:

are there any other known elements such as diet and excercise that can help redce the eye presure

Dr. James :

The current standard is Goldman tonometry (use of the blue light) in the office.

Dr. James :

Unfortunately, no diet and exercise for eye pressure.

Dr. James :

Your eye pressure elevation is likely a combination of the previous trauma, surgery, and pre-existing glaucoma.

Customer:

so u suggest that i should visit the clinic almost every day to check presure

Dr. James :

No, daily pressure checks are not necessary. It depends on the trends. If the pressures are increases, then you may need more frequent checks, such as every few weeks. For stable patients where the pressure is at goal, then every few months is appropriate.

Customer:

is it better to be regular with a glaucoma specialist or an normal opthomologist would b ok

Dr. James :

You case is difficult, so a glaucoma specialist would be preferable. If a glaucoma specialist is not available, then a general ophthalmologist would be OK.

Customer:

sir how can i save this chat . the contents are important for me to re collect.

Customer:

im generally a careless person and keeping this advice on record would help me

Dr. James :

Once the question is closed, you can return to the link provided in your emails to view the chat. You can print it out as well.

Customer:

many thanks doctor James. God bless you!

Dr. James :

You're welcome. Please remember to press the accept button so I can receive credit for assisting you.

Dr. James, Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 2282
Experience: Eye Physician and Surgeon
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