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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3159
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Hi, I suffered trauma to my right eye when I was 12 years old. As a result I had laser su

Resolved Question:

Hi, I suffered trauma to my right eye when I was 12 years old. As a result I had laser surgery to repair a detached retina and a tube shunt inserted to lower my eye pressure, as my eye's drainage system was damaged as a result of the trauma. I take eye drops daily and my pressure for the last 6 years has ben around 19 to 22 in that eye with my unaffected eye being in the 17 to 21 range. Recently, however I've noticed my right eye is starting to bulge somewhat and the pressure has increased to 30 and 24 in my last two visits. My doctor recommended I either have an express shunt put in or endocyclophotocoagulation. I have a few questions, what could be causing this sudden change in pressure? why is my eye starting to bulge? (it has always been somewhat bigger than the other eye after the shunt). and are there other alternatives to these surgeries as I would love to avoid another surgery?
Thank you very much for your time
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Dan B. replied 1 year ago.

Doctor DanB : Hello and thanks for your question. I think your first option should be to get a second opinion.
Doctor DanB : Especially if you're NOT currently seeing a glaucoma specialist. As to what would cause the pressure to go up now, it's possible that your existing tube shunt is failing. It's also possible that it works fine but for some other unknown reason the pressure is starting to rise (the most likely reason--many times we never know why).
Doctor DanB : As to whether to do the express shunt or endocyclophotocoagulation (ECP), I tend to think that ECP is probably not going to provide all the pressure lowering effect that you may need. However, each person is unique and its a difficult decision to make that depends on a myriad of factors including your exam, your anatomy, your response to drops, the extent of visual field damage, etc...
Doctor DanB : My best advice would be to seek a second opinion if you're at all concerned that either of these two option are not the best way for you to proceed. But unfortunately, for me to tell you exactly which way to go at thus point is somewhat like a lawyer who is watching a complicated trial play out on TV and who tries to second guess the attorneys involved when the aforementioned lawyer isn't aware of all the evidence and testimony. Does this maje sense?
Doctor DanB : Does this information help address your concerns? Do you have any other questions about this? It appears as though you are not in the chat room currently. I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need. If you would like to ask further questions or clarification regarding anything I've said, please let me know and I will be happy to address your concerns when I return to see if you've responded. If your concerns have been resolved...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: Hi doctor Dan,
Customer: hi doctor Dan, thank you for your answer. The doctor I'm currently seeing is a well respected glaucoma specialist at wills eye hospital in philadelphia. But I am seeing a second opinion in a few weeks about this as well. I just had a few more questions. What do you think could be causing by eye to bulge somewhat (I have an appointment with an oculoplastic surgeon in a week). And what is the post op recovery after the express shunt like? Could it cause further aesthetic changes to my eye(bulging,redness,etc)? And lastly are there other treatments other than Ecp or the express shunt? Thank you again for your time I was very satisfied with your answer.
Customer: If you could get back to me soon I would really appreciate it, thank you
Doctor DanB : The eye can become bigger because of increased pressure causing expansion of the tissues but also it can appear to bulge because of the inflammatory effects on the eyelid itself.
Doctor DanB : The postop recovery for the express shunt is relatively similar to that for a tube shunt although probably shorter in duration and with less inflammation and lower likelihood of complications.
Doctor DanB : If the eye bulging is related to generalized inflammation, then this could continue through the postoperative period as inflammation still an issue. And yes, there are other treatments besides these two. A traditional trabeculectomy instead of an express shunt can be done although it is more involved and is unlikely to be an option for you given your existing shunt. Diode cyclophotocoagulation is also an option versus ECP, but usually this is reserved for patients with a blind or near blind and painful eye (ECP is a much better option than this). Does all this make sense?
Customer: It does make sense, how can I reduce my eye inflammation are there over the counter medicines or prescriptions drops I should take for this? And how about an orbital decompression to fix this issue?
Doctor DanB : It depends on what is causing the inflammation, whether its high eye pressure or something else. It's unlikely that an orbital decompression is going to help this bulging but not impossible. It's a good idea that you're seeing the Oculoplastics specialist because they will be able to give you a definitive answer about that by evaluating you.
Customer: Ok thank you very much doctor your answers were very helpful
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3159
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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