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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Hi, I got hit by a soccer ball 3 months ago and was put on

Customer Question

Hi, I got hit by a soccer ball 3 months ago and was put on pred4 and combigan 2 weeks after that and told I had bruised the lense in inflammation. After 5 weeks I was tampered of the pred4 and told I still had inflammation and to use the pred4 without the combigan,after 3 weeks I had flashing and my pressure was 28,the eye dr colleague checked and said my eye wasn't damaged and I had a tear,I am off vexol on combigan and my pressure is 17 with inflamation and pigment would that raise my pressure
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Were you treated by an ophthalmologist or an optometrist?

Customer:

hi, I am seeing a ophthalmologist but I am going to see another one on Monday cause the current one keeps telling me different things

Customer:

the current opht said he wants to see the pressure at 14, I started off with pred4 then added combigan and after 5 weeks tamped off pred4 and still had inflammation and told to use the pred4 4 times a day without combigan and I got flashing 3 weeks later and switched to vexol with combigan and azaza and the pressure went from 28 to 21 then I was tampered off vexol and after a week it went to 37 then 4 days later 21 then 14 then 13, I stopped the azaga and jsut on combigan for 3 weeks and the pressure is 17 and he said it would go up if I stop the comibgan,is it possible I just need to stay on the combigan longer and the pressure would drop or are there other issues going on, he said my nerves and retina is good and combigan is something people can stay on for decades with no issue, I just want to find out what other issues could occure from getting hit in the eye and how to fix them

Dr. Rick :

ok

Dr. Rick :

did the colleague say where the tear was? Retina, perhaps?

Dr. Rick :

Well, if your ophthalmologist believes that your pressure will go up off the combigan, which I'm sure it would, and you didn't have pressure problems before, then the trauma to your eye may have damaged the channels that drain fluid out of your eye (angle structures). To determine this a special test in the office, called gonioscopy, could be done to evaluate this part of your eye.

Dr. Rick :

Also, has the inflammation gone away? Do you know if you had blood in your anterior chamber from the trauma (hyphema)?

Customer:

I think he said it was a small anterior tear and the retina was good, I am concerned about this pressure build up but I never had high pressure during the first 6 weeks after getting hit and the pressure only was a concern after I was tampered off pred4 and told to go back on it and I was pred4 another 3 weeks 4 times a day without the combigan when the flashing started, 2 weeks ago the flashing stopped

Dr. Rick :

I am a retina specialist. If there is any type of retinal tear, anterior or not, it would need to be treated. Or do you think he was talking about a tear in your iris, or possibly angle recession from the blunt trauma. This is an important distinction.....

Customer:

can the damaged channel be fixed? I still have inflammation and pigmentation and wanted to know if that would cause blockage in the drainage channel, I can't remember for sure where he said the tear was but said that the good news is you didn't damage the eye and what happens after a impact is the eye compresses then goes back to normal

Dr. Rick :

The flashing may be from a posterior vitreous detachment (PVD) most likely secondary to your trauma and possibly related to the inflammation inside your eye (if it was in the back of your eye too..) If the flashing has stopped, and the doc say's your vitreous has completely detached then your risk of a retinal detachment would be low at this time. If the PVD is not complete and you have an untreated retinal tear your risk of a retinal detachment would be higher.

Dr. Rick :

No. In the vast majority damage to angle structures can not be fixed. Yes. Pigment and inflammation cells can block the drainage channels in some cases but sometimes your body can clean things up some.

Customer:

I am just scared that the drainage might be damaged and would get worse

Dr. Rick :

Yes. Your eye deforms when it is hit, like a slowmotion picture of a squash ball hitting the wall. It then bounces back to shape, if it doesn't rupture like a grape....it is this deformation that causes a lot of the problems.

Dr. Rick :

That is a possibility from what you have told me. However, it does sound like you are getting very good care.....with the exception that I'm not sure what was meant by a small anterior tear that doesn't need treatment.....

Dr. Rick :

Do you think that the colleague that examined you was a retina specialist?

Customer:

I am 39 right now and on combigan drops twice a day, what kind of outlook do you think I have with respect to keeping the vision in my left eye, right now I am 20/40 in my left eye and want to join the police force, I am not sure what to colleague specialist is I knwo he is a surgeon

Dr. Rick :

I neglected to address one of your questions above. If there is a large amount of blood in your eye you could actually see it in the mirror. In many cases, however, it is small (microhyphema) and only the ophthalmologist can see it with the aid of a slit lamp.

Customer:

I think there isn't much blood in my eye

Dr. Rick :

Did the doctors tell you why they think that your best corrected visual acuity is 20/40 at this point? Or is this your vision without your new, best glasses in place?

Dr. Rick :

That is good....in any event I would expect the blood to be resorbed by now

Customer:

uncorrected it is 20/40 and 20/20 corrected had it checked 2 days ago

Dr. Rick :

That is good news.....20/20 is very good, and the fact that you get this excellent vision with glasses tells me that the important part of your retina is OK along with your cornea, lens and media (the goop inside your eye) is clear.

Dr. Rick :

In the USA your uncorrected vision is not as important as your vision with glasses when it come to being a police officer.

Customer:

I am in Canada I need 20/40 uncorrected, should I be concerned about the long term (10,20,30 years) with damage to the drainage system?

Dr. Rick :

Just one other thought....is the eye doctor who is currently treating you an eye surgeon (ophthalmologist) or some other kind of eye care person?

Dr. Rick :

Well, I'm glad you are not worse then 20/40 uncorrected......There is no way to predict the future, especially since I'm unable to examine your eye, drainage system and retina myself. Right now I wouldn't worry about the possibility of future problems and just do your best to make sure your eye pressure is controlled so as to prevent any further damage.

Customer:

he is a ophthalmologist and surgeon, he just opened a office and said to me most other's would tell you to come in once every 6 months but he wants to take on top of things and knock the inflammation out, now he is saying he wants to manage the pressure over the next couple of months and decide treatment options

Dr. Rick :

That sound like an excellent plan.

Dr. Rick :

I've been doing this for almost two decades now and I agree....better to keep a close eye on things then be surprised by a problem six months later.

Dr. Rick :

Although ask him to clarify what this issue with the anterior tear is........especially if it involved the retina.

Customer:

can someone be on pressure medication drops the rest of their life and expect good results, I am hoping to keep the pressure in my left eye stable for 25 years until retirement

Dr. Rick :

Yes. George Bush ran the entire USA while on Glaucoma meds....and I don't think it was the drops that made him the President he was lol!

Dr. Rick :

So you don't have to worry about doing a poor job while on the drops (couldn't avoid the political comment....sorry. ;)

Dr. Rick :

And I would rather that you keep the pressure stable in your eyes until the day you pass on, rather then just to retirement...

Customer:

haha I didn't know that, my emotions have been up and down guess this is a bit positive, definatley staying out of politics, I am seeing another opth on Monday heard this person is better and would explain things better, could I email you next week or in the future if I have questions?

Dr. Rick :

You sure can. Even after you accept this answer you can come back to this thread and tel me how things are going at no additional charge. You can also post to the thread at the bottom of this chat but you might have to leave a deposit then, although there is no need to press accept, and then you wouldn't be charged. But, that being said, I'd love to hear back from you on how things are going.

Dr. Rick :

The link that will show up when I finish will take your question directly to me.....

Dr. Rick :

I'm glad you are feeling a bit more positive. You have been through some ruff times but it does sound like your doc has been doing right by you. Hopefully this new doc will be better at explaining things.....

Customer:

okay, thanks I feel a little better , this has been bother me since Wednesday

Customer:

thanks again

Dr. Rick :

My pleasure. I look forward to hearing from you again. Take care and have a good day.

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)


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Expert:  Dr. Rick replied 2 years ago.
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Expert:  Dr. Rick replied 2 years ago.
there is the link that goes directly to me......Let me know if there is anything else I can do to help you.
Customer: replied 2 years ago.
Hi Dr Rick

Good news I went to get a 2nd opinion and my eye is okay, no damage to the retina, lens, nerves, iris and the drainage system. There is no tear in either the retina and anterior chamber. The pressure is still 17 but that was in the morning and from what I understand it drops a bit during the day. The Dr I saw was great I told her everything and she checked it all out and said if I just got hit and came in she would say everything is fine, she even said I could stop taking the Combigan but too stay on it since I am going to see my original OPTH next month. She also said there is no inflammation or pigmentation in the front and back and previously both might of been clogging things up before as well as waiting for the vexol to clear my system. Best of all I am 20/30 in my left eye (20/25 in the right) uncorrected (20/20 in both eyes with glasses light prescription) and she said I should have no problem with the police test. Until I am off the Combigan I am still recovering and I am going to get checkups every 6 months but with no major damage I am lucky and greatful I still have a chance to pursue. Thanks again for your help. Let me know when I can hit Accept Answer, thanks
Expert:  Dr. Rick replied 2 years ago.
Thanks for the information. I am very, very glad to hear the excellent news about your eye and that you will have no problems with the Police exam.

Also, it sounds like you have found yourself a new eye doctor should you ever need one in the future, eh?

It has been a pleasure helping you.....and it is safe to mash the accept button anytime you like. And, should you feel so inclined, feel free to give me positive feedback :-)

Best of luck to you. Take care and have a wonderful day!
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.
Hi Dr. Rick. Sorry for not responding sooner was a bit busy earlier today putting on my snow shoes and building my igoo eh :-). Good chatting with you the other day, thanks again.
Expert:  Dr. Rick replied 2 years ago.
My pleasure.

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