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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3131
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Ive just had cataract and LSEK surgeries and have been prescribed

Resolved Question:

I've just had cataract and LSEK surgeries and have been prescribed antibiotic ,NSAID and pred forte eye drops. I've experienced a raise in blood pressure, drenching sweats and a general over amped feeling. These symptoms began within a day of beginning the drops.
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Dan B. replied 1 year ago.

Doctor DanB : Hello and thanks for your question. Are you available to chat?
Customer: Yes
Doctor DanB : Did you use the drops prior to the surgery?
Customer: Yes, and they'd already raised my BP in 2 days
Doctor DanB :

How much?

Customer: Having had a bad prednisone experience before coupled with the sudden BP change has me concerned.
Doctor DanB :

Similar side effects with taking prednisone before, I assume? Was this oral prednisone? How much has your BP changed?

Customer: Sorry I didn't read your response before answering 4 drops a day and I've continued.
Customer: I do remember Dr asking me if I'd had a Red Bull when I was on the table.
Customer: As I said, I felt wired and have continued to feel more so.
Doctor DanB :

How old are you and what other medical problems do you have?

Customer: BP had been at 115 over 75. It was 160 over 90 tonight
Customer: The other prednisone was for nasal to deal with sinus infection. I stopped after 3 days. Finally realized the infection was because of repeated antibiotics. Stopped the prednisone and made a full recovery. Have not used pred nor antibiotics for over 20 years!
Doctor DanB :

While it's quite uncommon to have significant systemic side effects from just using the prednisolone drops, it is not unheard of, or even rare. It does sound as though you are being affected by the steroid drops (the other two drops would not be expected to cause these symptoms). I would recommend stopping the steroid drop (stay on the other drops) and notify your doctor in the morning. Your BP escalating that much is certainly enough of a reason to be careful with using steroids. Your eye surgeon may have to manage your post-operative inflammation with the NSAIDs alone. Does this make sense?

Customer: I'm 65 and am in incredibly good health. I eat very well, do not need to take prescription drugs except for Cytomel/ T3.
Customer: You better believe it makes sense. Because I'm so healthy my body knows when things aren't right. You have confirmed such. So, should I stop completely; or taper. I suppose I've not been on them long enough to taper. I know the last time I stopped and it was over as quickly as it began!
Doctor DanB :

I would just stop them now, but be sure to call your surgeon to make sure they don't want to see you sooner rather than later. Do you have any other questions about this that I can help you with?

Customer: By the way, I take Naproxin and have never had an ill effect
Customer: I'm scheduled to see another Dr. On this Wednesday as mine will be out of town. However, these are really top tier physicians and I'm told the other will be as good. I'm so happy to have had this chance to speak with you.as far as other questions I'll formulate them now
Doctor DanB :

Sounds good. I'll wait to see if you have any more.

Customer: On the plus side my eye has made a dramatic recovery. I suffered from Fuchs Dystrophy and Cataracts. My second eye is to be done when this one is semi healed. They've already measured it. I'd mentioned the previous prednisone problem to the scheduling nurse but she said it was always their procedure. So, the botXXXXX XXXXXne line is; am I understanding correctly that NSAIDs could be used to prevent inflammation. On their own? As I said, I'm a believer in judicious use of them
Customer: My redness is down to nothing , my sight is clear as a bell and swelling is not an issue, by the way.
Doctor DanB :

NSAIDs are very effective at limiting inflammation--they won't prevent it completely, but they certainly do help limit inflammation. However, outside of steroids, the body really does the best at helping to control inflammation. NSAIDs are just a very nice adjunctive treatment to help the body along in that process. If your side effects are as as significant as they seem, your surgeon may elect to keep you off the steroids and just do the NSAIDs and antibiotics.

Customer: All if have to say is THANK YOU! Do I have a transcript of this conversation or may you suggest a way for me to print it just for my records?
Doctor DanB :

There should be a link on your page that says 'share'. If you hover your cursor over this, it should give you the option to either print out or email the transcript to yourself. If that fails, I would recommend just selecting the text with your mouse cursor, hitting Ctrl+C, and then opening up a word processor document such as Microsoft Word, hitting Ctrl+V (paste) and that will allow you to keep the transcript. Make sense?

Customer: Oh, totally. However, I'm on an IPad and I have a feature that allows me to print or email a text if I'm on a web site. But since this is a chat I'm not sure. Would that work?
Doctor DanB :

I would give it a shot. I too am on an iPad and I do know this site can be a bit squirrely with apple products. If all else fails, you can email the website administrators to see if they can get it to you.

Customer: So, here's what I'm going to do; I'll take a photo of each part of our chat and will let you know whether it worked when I've finished ; OK?
Doctor DanB :

Sounds good. Let me know.

Customer: YIPPEE! It worked; it took about 8 shots but because it's an IPhone 5, I was able to expand the text on the photo. That way I could get the width and not miss any words. I'll also be able to use the other techniques you suggested as I have the saved texts. I'm going to try to email and will let you know if there's anything else. Concerning the pred forte, I've even used the technique of blocking off my tear ducts to prevents systemic involvement but no technique can outsmart our own bodies!
Doctor DanB :

Hmm.. I guess there's no outsmarting your body at least! Sounds like you're on top of things! Do you have any other questions about this?

Customer: One last question; in your opinion, how long should I wait before having my second eye done? Also, I had utacaria 20 years ago and the allergist said it would gradually go away (which it did). What I'd like to know was since my Fuchs first presented itself when I was 37 (I just thought I had old people's eyes: my friends think that hilarious) but I didn't know everybody else's vision didn't look like it was covered in Vaseline. Anyway, could the Utacaria have been part of the Fuch's development?
Customer: Since I have no other allergies, It always seemed strange that I'd have hive in my eyes
Doctor DanB :

I have absolutely no reason to suspect or expect that the urticarial you experienced was part of the Fuch's development. Fuchs dystrophy is a congenital/inherited trait that is not known to be affected/exacerbated/caused by urticarial. But Fuchs isn't really hives in your eye--it is a congenital anatomical abnormality that causes a dysfunction of the water-pumping cells in the cornea, leading to corneal swelling (edema)--it's not an allergic reaction. I think waiting a couple of weeks between the two eyes (especially if the first is doing well) is quite reasonable.

Customer: A couple weeks seems a good Idea to me too. But they're talking about 2 months. Also, What is the usual length of pred forte use for my situation. And am I taking it for the Corneal tissue transplant or cataracts or both ? There seems to be some over lap of info.
Doctor DanB :

Yes, you're taking it for both. I can't really speak to why they want to wait 2 months if everything is going quite well, other than this is an involved surgery and they want to give the eye more time to heal before doing the other (?). Every surgeon's regimen for taking pred forte is different, but in your situation, I could see your surgeon wanting you on it for at least 1-2 weeks, or longer.

Customer: That seems to line up with what I've read. However, before the procedure 9 months was mentioned but......that's a really long time and
Customer: there's so much data indicating the dangers of long term use.
Doctor DanB :

Yes, there can be issues with cataract formation (not a problem for you), and some people can have eye pressure rises on steroids (that can uncommonly lead to glaucoma). So certainly the risks must be balanced against the benefits, but in someone with cataracts and visually significant Fuchs dystrophy, I think in most cases the benefits would outweigh the risks.

Customer: Finally, FYI, I'm taking NAC, Astaxanthing, Hyaluronic Acid and have seen positive blood test result improvements, Like my Triglyceriides are 35 and my HDL is higher than my LDL (as is with my husband). That's what I meant about being healthy. So, in closing, all I can say is thanks again and after photoing the last few lines I'll let you know so we can sign off
Doctor DanB :

Sure. I'll wait for your okay.

Customer: Done and done. So, is there any way I may contact you again?
Doctor DanB :

Absolutely. You can just come on and request me by name! I'd be happy to chat again with you.

Customer: One last thought, am I also feeling a weird kind of depression as a side effect? Just had to get that one in before closing. I'm normally very social and positive but is this a physiological possibility?
Doctor DanB :

It's possible that the prednisone may be exacerbating that, but I doubt if it is the sole cause--though, of course, hopefully it just goes away like the other side effects once you stop it :)

Customer: Yup, that what I suspected as I seem to recall this sensation from the last prednisone experience. It would seem a hand in glove with the wired feeling as anxiety and depression seem to go together in so many people. A fabulous good morning to you! Oh yeah, I do give great feed-back...
Doctor DanB :

Good luck to you. Hope this has been helpful and I'm happy to converse again in the future. Good night/morning.

Doctor DanB :

Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your
concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and
unsatisfied.

My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation
you must see an eye doctor. Thanks for your inquiry!





Customer: So I gave u a big happy face but don't know where to leave my written feed back? Do I have that opportunity after pushing the 'submit' button?
Doctor DanB :

yes, you should

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3131
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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