Beware of use of steroid drops!

[rkralman]

I was just diagnosed with steroid-induced glaucoma two weeks ago. Pressure in eye was 35 but once steroid was stopped the pressure went down to 14. There seems to be some damage already done to the optic nerve as I have lost a litle vison in some spots of my eye. Very scary. This is fairly uncommon in that my doctor states 4% of the population are steroid-responders and have this reaction. I am one of the unlucky ones who cannot ever use steroids again. The problem was the doc was prescribing Tobramax because he did not have time to see me in the office. I had been on Alrex for two weeks and the inflammation was not better so he just had me pick up MORE steroids without checking my pressure. This was very dangerous for me but I didn't know it at the time. Once pain and blurry vision started I tried to get into Doc but no one answered their phone. Saw another doc and he checked pressure and was astouded by how high the pressure in the eye was. Be very careful that if you are placed on steroids, your doc is checking your pressure regularly. It could be disasterous for those who are steroid-responders and don't even know it!

[Kyle]

I know Dr. G had posted a very lengthy thread about this before with another steroid user. You might want to go back in the archives and look that up again.
I'm sorry that happened to you. I know my experience with steroids wasn't a good one either. My eyes flipped out and turned a bright red and burned like crazy. Hopefully they caught your situation in enough time and, thankfully, you caught it before you created even more damage to your eye.

[Rebecca Petris]

I was just diagnosed with steroid-induced glaucoma two weeks ago. Pressure in eye was 35 but once steroid was stopped the pressure went down to 14. There seems to be some damage already done to the optic nerve as I have lost a litle vison in some spots of my eye. Very scary. This is fairly uncommon in that my doctor states 4% of the population are steroid-responders and have this reaction.

I am so, so sorry to hear this!! That's terrible. I really appreciate your posting about the 4%, and the whole experience, so others know to be cautious. I had no idea someone could have a reaction like this so soon after starting these drops.

[rkralman]

Thanks for the words of encouragement. I noticed I typed Tobramax, but the correct drug that I reacted to was Tobradex. Sorry for the mistake. This med is usually a really good one since it has an antibiotic and steroid to it, but it sure was a negative experience for me. The funny thing is I have used this drug before but with no negative effects (although the doc wasn't checking the pressure then either so it's hard to say what happened when I've used it before). From what I understand, it was the combination of Alrex for 2-3 weeks and then when I did not get the inflammation cleared up on this drug, the doc added yet another steroid on top of it (Tobradex), and this is when I had the increase in eye pressure that was so painful. Please remember, for MOST people, these drugs are safe...it is just a few of us that cannot use these drugs without complications.

[Rebecca Petris]

Guess the take-home message is be aware of changes in sensation and get checked out and IOP monitored if in doubt.

Lotemax, Tobradex... easy to confuse, hence Tobramax, Lotadex .

[DrG]

The previous thread on the subject of topical corticosteroids may be found here.

DrG

[rkralman]

Thanks for the link DrG. I read with great interest your advice. Although I was told by the doc I was a steroid responder several months ago, he continued to prescribe steroids to me for the short term to get inflammation under control. Again, for the majority of the population, this is fine, however, for me , it was disasterous. I think the average patient hears some of these things at the eye doc, but does not have enough knowledge as to the problems that can develop and does not question the doc when a decision is made about the treatment. I just assumed the doc was making the right decision for me, but as it turns out, this was not the case. The main message here is to have eye pressure checked regularly when on ANY type of steroid. The other interesting thing I learned is that my steroid nasal spray had also been raising my eye pressure (according to the doc). I have been on this for years and had no idea I was contributing to a high intraocular pressure by using this along with the Tobradex (and all of the other steroids I was prescribed) Thank goodness the problem was caught before any more damage could happen and I have an excellent chance of getting my eyes back to a healthy state. Now if I could just find an anti-inflammatory that works as well as a steroid I would be in heaven!

[DrG]

If a patient who is a steroid responder requires a steroid, then a pressure-lowering agent can be used concommitantly.

I would be surprised if a pressure of 35 mmHg for a short period of time would cause any permanent problems. You might retake the visual fields in a few months and find that things are OK.

DrG

[rkralman]

That's true, testing will be done again in one month from my understanding. The test he performed was one in which I sat and pressed a button every time I saw a light at different locations inside this tunnel. The results from this test showed that I had many occasions in which I did not see the light. It is my understanding that once the pressure goes down, my eyesight will improve and I'll be in pretty good shape. Thanks for the feedback, I really appreciate you taking the time to respond. RKK

[kaypeeoh]

That's true, testing will be done again in one month from my understanding. The test he performed was one in which I sat and pressed a button every time I saw a light at different locations inside this tunnel. The results from this test showed that I had many occasions in which I did not see the light. It is my understanding that once the pressure goes down, my eyesight will improve and I'll be in pretty good shape. Thanks for the feedback, I really appreciate you taking the time to respond. RKK

I remember that test. I had a GRX exam at an O.D. clinic that said I had glaucoma. My pressures were normal. I had had LASIK a few years prior. I went to a glaucoma specialist and had a poor result when sitting in the tunnel. Because of LASIK small pinpoints of light are dim a look 'smeared'. While trying to decide whether I saw a pinpoint or not, another spot would appear. Eventually I became good at responding to the dim spots. After three years of re-exams the doctor decided I didn't need to come back anymore.

What I found out from researching on Medline was that the GRX result can be affected by LASIK, giving false indications of optic nerve damage. On my last exam I noticed the GRX machine isn't there anymore.

[Magadass]

I was just diagnosed with steroid-induced glaucoma two weeks ago. Pressure in eye was 35 but once steroid was stopped the pressure went down to 14. There seems to be some damage already done to the optic nerve as I have lost a litle vison in some spots of my eye. Very scary. This is fairly uncommon in that my doctor states 4% of the population are steroid-responders and have this reaction. I am one of the unlucky ones who cannot ever use steroids again. The problem was the doc was prescribing Tobramax because he did not have time to see me in the office. I had been on Alrex for two weeks and the inflammation was not better so he just had me pick up MORE steroids without checking my pressure. This was very dangerous for me but I didn't know it at the time. Once pain and blurry vision started I tried to get into Doc but no one answered their phone. Saw another doc and he checked pressure and was astouded by how high the pressure in the eye was. Be very careful that if you are placed on steroids, your doc is checking your pressure regularly. It could be disasterous for those who are steroid-responders and don't even know it!

Are you taking the steroid for pain relief from a joint/muscle? I know if thats the case injections into the area are better without alot of the effects of the steroid pak doctors put people on. I actually insisted on an epidural injection for my back instead of the pak since I wanted to avoid the horrible effects of steroids that are downplayed by doctors...

[southhavenjen]

Hi everyone, I am new to this board and just came across this posting about steroid eyedrops. My doctor just put me on these two weeks ago to try to get my dry eye under control, but reading this thread has gotten me worried!

I am on Alrex, and it really is helping with the redness and inflammation. I have been on it two weeks and have been instilling it in my eyes 3x per day.

For the next two weeks, I am to instill it for 2x per day.

For the final two weeks, I am to instill it 1x per day.

Then I have a checkup with my doctor.

Should I be concerned he is not checking my eye pressure at all during the 6 weeks I will be on Alrex? I understand it is one of the "lighter" steroids but I certainly don't need glaucoma on top of my other eye troubles. Can Dr.G or anyone else give their opinion on this regimen?

[Lucy]

Jen, I'm posting the Alrex info from the FDA site.


http://www.fda.gov/cder/consumerinfo/druginfo/alrex.htm

Here is part of the info included in the site:

General Precautions with Alrex:
You should contact your doctor if pain develops, or if redness or itching gets worse.
Tell your doctor if your symptoms do not get better within two days. He/she may want to re-evaluate your condition.
You should not use Alrex longer than 10 days without having the pressure in your eye checked by your doctor.

[southhavenjen]

Now that you posted that, I do remember seeing that in the product insert. Hmmm.....

[DrG]

Should I be concerned he is not checking my eye pressure at all during the 6 weeks I will be on Alrex? I understand it is one of the "lighter" steroids but I certainly don't need glaucoma on top of my other eye troubles. Can Dr.G or anyone else give their opinion on this regimen?

I don't have a problem with the regimen, but I am personally very uncomfortable with waiting more than two weeks before checking the eye pressure. I wouldn't go overboard with anxiety just yet, because you are (1) in the tapering phase of the drug, and (2) even IF the pressure is elevated, in all probability it will go back down when the drug is discontinued, and (3) in the event that it does not, it will be caught when you go back in a few weeks.

[diane wordsmith]

I'm hoping Dr G can answer this. I've heard that you can get false eye pressure readings after having Lasik. (In other words, pressure is really high, but registers as normal.) Is this true? I was using Tobradex (steroid) ointment over a long period time and was worried about my pressure. The ophalmologist said it was ok, but later I read of this phenomenon that can happen after Lasik. Should I have my pressure checked by an alternate method?

[southhavenjen]

Thanks for the reply, Dr. G!

[Leo]

REBECCA SPEAKING... OOPS AND MY APOLOGIES TO LEO

I tried to quote your post while replying to it, and I inadvertently edited your post!! Couldn't get back the original, except for the part I was quoting:

"...he said I should use Tobradex now twice a day for one more week. Should I ignore his advice and stop using it?"

And my reply was (well originally it was much wordier) No.

Sorry! Never did that before. I'll be more careful.
Rebecca

[dianat]

Leo,

If you feel you are being well-monitored by your doctor and you trust him/her, I would continue with the treatment as suggested. I am guessing your doctor is concerned with discontinuing too abruptly and causing the symptoms to return.

I believe steroids are safe so long as you are being seen by a competent physician. In my opinion, it was sheer malpractice that caused the damage to the patient who started this thread.

Diana