High Eye Pressure after Cataract Surgery

Dr. Gary Foster – Fort Collins & Loveland, CO

High eye pressure after cataract surgery and cataract surgery lowers eye pressure

Eye Pressure After Cataract Surgery

There is good news and bad news about the pressure in the eyes after cataract removal. The good news is that cataract surgery tends to lower eye pressure once you heal. The bad news is that cataract surgery can raise pressure for the first week or so while you are healing.

High Eye Pressure after Cataract Removal

Fluid is being made in your eyes every minute of every day.  This fluid escapes the eyes right where your cornea and your iris connect.  We call this area “the angle.”

To protect your eyes and keep it formed during the procedure, we place a thick substance inside your eyes called “Viscoelastic.”  This viscoelastic is one of the great advances of modern cataract removal.  At the end of the procedure, we remove most of the viscoelastic, but some always remains.  This slowly dissolves and is absorbed by your eyes.

In addition, your eyes release proteins during surgery.  Both the thick fluid from the proteins released and the retained viscoelastic slow how fast fluid leaves the eyes.  This can cause pressure in your eye to temporarily go up for the first week or two after your cataract removal procedure.

If eye pressure is just moderately elevated, the eye doctor will notice it the next day at your postop visit.  He/she will likely prescribe an eye drop like Timolol, Alphagan, Azopt, Combigan, or Travatan.

Once the thicker fluid is cleared from the eye, the eye pressure returns to normal and the eye pressure drop is stopped.

Complications of Cataract Surgery

If the pressure is dangerously elevated, it will usually cause eyeaches (like a tooth ache) and sometimes it will even make you feel nauseated the evening after your surgery.  This is one of the potential complications of cataracts surgery.

If this happens, then it is important you call your expert eye surgeon that night.  If the pressure is elevated, eye drops will be started or other techniques employed to lower pressure , make you comfortable, and protect your vision.

After surgery we usually have you take a steroidal anti-inflammatory drop.  These are very helpful for most patients in their healing process.  However, in a small percentage of patients, they can cause discomfort  to go up after using them for several weeks.  This is part of the reason we see you for follow up appointments.  If your discomfort does rise, the steroid drop is often discontinued and pressure-lowering drops may be started to return your eye to normal.

Lower Eye Pressure After Cataract Surgery Healing

At the last meeting of the American Society of Cataract and Refractive Surgeons (ASCRS) last spring, I was asked to present data on the long term effects of cataract surgery on eye pressure in a Glaucoma/Cataract Symposium.

The good news is that, on average, surgery does lower the discomfort in our eyes once you are fully healed.  The higher your pressure before the procedure, the more the discomfort tends to lower.

This is particularly beneficial for those with glaucoma that really need to have lower pressure in your eye for the long-term safety of their eyes.

Microstents to Lower Intraocular Pressure After Cataract Removal Surgery

In recent years, a number of micro stents have been developed to lower pressure in your eye even more than surgery alone.  These are inserted into the angle at the time of surgery to increase the flow of fluid out of the eye long term.

The iStent is already FDA approved and does a good job for patients.  I am currently in FDA trials for two other products that also aim to help those with glaucoma lower there pressure even further after cataract removal.  These are made by Transcend and Glaukos.  I will keep you posted on these options as the data from the studies becomes public.

If I can provide any further information about eye pressure and cataract surgery, please leave a comment or contact me at my office.

Comments

  1. Brian Kulash says:

    Hello,
    I have a friend who recently had cataract surgery.
    He has a big phobia about eye stuff and has asked me to do a lot of his internet searching in regard to eye things as most articles feature graphic images of eyes and/or eye surgery.

    He wanted to know if smoking cannibis (where we live its legal) after his eye surgery, a few days at least, is a bad idea due to the pressure lowering properties.

    Would it pose any risks?
    Thanks!

    • Brian:
      It would be best to avoid cannibis use for the first 24-48 hours due to the other anesthetics used at the time of cataract surgery. There after, the presure lowering effects of cannibis would not negatively affect the healing.
      Gary Foster

  2. My mum is glaucoma patient. Her eye pressure is always high. Doctors advise her to do cataract surgery?.can she get blind.?

    • Cataract surgery is the most commonly performed surgery in the world and it is one of the most successful surgeries. Having said that, blindness is a rare but possible complication from cataract surgery. The good news is that cataract surgery alone does tend to lower the intraocular pressure after the eye heals. In addition, there are options like the iStent that can be used at the time of cataract surgery to even further lower the eye pressure. I have many patient that have had cataract surgery with the placement of an iStent that no longer need to use glaucoma drops. If the glaucoma is more advanced, then cataract surgery with the placement of an Express Shunt is another potential option. I hope this helps
      God Bless,
      Gary Foster

  3. Hi
    My 6 months old daughter had the cataract surgery on both eyes about 3 weeks ago (with a week gap between). She has the implant lenses in both eyes and due to the doctor, operations were fine without any complication. However in the right eye she has the eye pressure (21.7). She got these drops (Dexamethasone 0.1% 4times a day, Cyclopentolate 0.5% once, Chloramphenicol 0.5% twice, Dorzolamide/Timolol once and Maxitrol ointment once before night sleep). It’s so difficult to apply the drops as she is so young and absolutely hates it! Sometimes it just impossible to do it correctly, e.g. it goes more or less than 1 drop. So I wonder what should I do to help her!I’m so worried about the eye pressure… Many thanks indeed for your time.
    Regards,
    Leila

    • Leila:
      Your daughter is blessed to have such a loving mother. It is very difficult to administer the drops. As a parent, I found it much easier to put the ointment in my children than the drops. Normal eye pressure is 10-21 mm Hg. If your daughter’s pressure is 21.7 then it is essentially in the normal range. This would mean that you are getting in enough drops to protect her little eyes. If the pressure where to rise to a dangerous level, then sometimes it is helpful to have more than one person help with the drops so that one can hold the infant while the other puts in the drops.
      God Bless,
      Gary Foster

  4. Dear Dr Foster,

    My father recently had a Cataract Surgery with the placement of an Express Shunt as the treatment for Glaucoma. It has already been 6 days after the surgery, however the IOP still remains at the level of appoximately 35-37 mmHg; though the pressure drops right after the eye massage to 15-17mmHg (but it again rises to 30th to the next morning). What could be the reason of this (improper surgery? maybe shunt clugged up?) what could be done in this case? Doctor that made the surgery says it’s just an individual reaction… Please advise! Thank you

    • Dmitry: I am sorry the express shunt surgery is only working intermittently, but the healing pattern you are describing still has the potential of a great outcome. The shunt is covered with a half thickness flap of sclera and then conjunctiva. These tissues are there to make sure that the shunt doesn’t allow too much fluid to leave the eye through the express shunt. When I use the express shunt, I secure the edges of the scleral flap down with some 10.0 nylon suture. This limits the outflow of fluid. Once a patient is out 2 or three weeks, if the pressure is still rising in between massage, a surgeon can use a laser to cut the suture and release the flap edges. This allows more fluid to leave the eye and the pressure to stabilize at a normal level. If the surgeon cuts the suture too soon, before the sclera begins to heal, too much fluid can flow and the pressure drops too low. If the surgeon waits too long, then the scleral flap scars down too much and cutting the sutures doesn’t make a difference. Adjusting the pressure and finding a soft landing on great pressure is a delicate dance. So far, it appears your father’s course is right on track.
      God Bless,
      Gary Foster

      • Dear Dr Foster,

        Thank you so much for your explanation! I really appreciate your clarification on this matter. Hopefully my father’s IOP will normalize and he will keep his vision.

        Thank you again!
        Sincerest regards,

        Dmitry

      • What a caring response.

  5. Hello Doctor Foster. For clarity sake, let me please start by saying, ”You are NOT the surgeon that performed my cataract surgery.” I am 47 years old. I had cataract surgery 6 weeks ago on my right eye and 5 weeks ago on my left eye. I chose to have a high quality multifocal lens implanted into both my eyes to correct both my near sighted and far sighted vision. I also paid extra for the bladeless surgery. At one of my follow up appointments at 3 and a half weeks after the surgery, the eye pressure in my right eye was 39. They re-adjusted the meter and came up with another score of 36 in my right eye. The doctor put me on a sample of Combigan and told me to use it in both eyes, twice a day and he wanted to see me again in 3 days. Three days later when I went back for another follow-up appointment…. The Combigan worked perfectly and lowered my pressure down to 13. I ran out of the Combigan sample after a total of 10 days and then I started to see halos and experience the impaired vision again, along with the small fog spots had started back again. Also, the headaches were back. It was the weekend, so I contacted my doctor via text. He was out of town, but he phoned me in a prescription for Combigan. Low and behold, my vision began to clear after an hour of starting back on the Combigan eye drops. It’s been five days now since I’ve been back on the Combigan and I absolutely hate the side effects I am experiencing from these eye drops. Can you please tell me whether or not my eye pressure is rising because of the surgery. Is my eye pressure rising because of the cataract surgery? The eye pressure in my right eye prior to my surgery was 22. Also, I was NEVER told that I have glaucoma, but now I see that the drops he prescribed for me are those that a doctor prescribes for patients with Glaucoma. This is extremely upsetting. Is this simply a part of the healing process from my cataract surgery or am I now looking at daily eye drops twice a day for the rest of my life? I’m feeling very discouraged. I go back for another follow-up appointment in 2 weeks. Any suggestions or advice would be greatly appreciated.

    • Nichole: I am sorry you are having eye pressure problems after cataract surgery. Usually, if you did not have high eye pressure before cataract surgery, it ultimately returns to normal pressure without drops after you heal. In fact, cataract surgery tends to result in lower eye pressure after the healing is done.

      During the healing phase the pressure goes up in a small percentage of patients. This can occur due to the thick viscoelastic material a surgeon puts inside your eye protect it during the cataract surgery. This dissolves and is usually gone after a few days. There is another group of patients that are steroid responders, meaning that their pressure rises due to the steroid anti inflammatory drops taken after cataract surgery. These patients need the glaucoma drops to lower the pressure until all of the steroid effects are gone a month or two after the steroid drops have been discontinued.

      If you are having significant effects from the combigan, there are a number of different glaucoma drops that could be tried instead of the combigan or perhaps the steroid drops could be stopped at an earlier phase of healing.
      God Bless,
      Gary Foster

  6. Hi doctor,

    3 years back my daddy had under gone catract opratio . There was the problem of not used correct size of lence in replacement so since opeation the eys are getting red/ as per doctor they say Eye pressure is increased and suggest some drop. but pressure was coutinue till today. doctor not giving any permentent solution for it
    they to oprate the eye else he will losse the eye site.

    is this correct ?

    • Sachin:
      I am sorry your father is having these problems. What type of replacement lens was used?
      If I understand you correctly, the eye drops are not adequately controlling the eye pressure and they are proposing a surgery for his glaucoma. I can only say that it is important to control the eye pressure to preserve good vision and that if the pressure is high enough that visual loss is occurring that we often recommend glaucoma surgery to protect the vision.
      God Bless,
      Gary Foster

  7. gary johnson says:

    Greetings: I have gone thru 3 eye surgerys for A torn , detached, and bulged retina.
    The last surgery was in January of thus year. At that time the eye was filled with silicone oil, The surgeon will not remove the oil because of low eye pressure. The pressure is at a 6 and he would like to see it at least a 12 before removing the oil.
    What would be a good process of increassing the pressure in my eye to a prober level so the oil can be removed???
    Thanks for your help..
    Gary…

    • Gary: I am sorry you have had so many complicated problems with your retina. Significant eye trauma from multiple surgeries can affect the ciliary body, which is the part of the eye that makes fluid and creates eye pressure. Normal pressure is 10-20. If pressure is lower than this, it could represent a poorly functioning ciliary body. Your surgeon may be afraid of an additional surgery that could affect the ciliary body and lower the pressure further below the normal level or stop it working altogether. We do not have a known treatment to revitalize the ciliary body so your surgeon is likely hoping the that the eye will rejuvenate and return to more normal function on its own.
      God Bless,
      Gary Foster

  8. Hi doctor. I had a cataract surgery about a month before. My pressure stayed fine for 2 weeks but then it went up to 39. I am a glaucoma patient too. I am on maximum drops already. The pressure was well under control before the surgery. It stayed fine after the surgery too but only for 2 weeks. Now adays I mean using all drops and diamox too for lowering the pressure. But nothing seems to work. I cant sleep due to pain in eyes and head…if I lay down the pain becomes worse. I only had the cataract surgery done in one eye but pressure of both eyes is high. Plz guide me…

    • Nadia: Sorry for your troubles. You have just described the course of a steroid responder. Your pressure was fine for the first few weeks, but after being on a corticosteroid for several weeks your pressure began to rise. If inflammation is well controlled, most surgeons stop the steroid or switch to a weaker steroid if the pressure is hard to control. If you are on a non-steroidal anti inflammatory (NSAID), it makes it easer to get off of the steroid since these drops will still help control inflammation when the steroid is stopped. Sometimes it takes several months for the steroid pressure elevation to resolve. During that time, maximum medical management is attempted. If a patient already has weakened nerves from glaucoma, sometimes a glaucoma surgery must be used to lower the pressure and protect vision.
      God Bless,
      Gary Foster

  9. Morley Goldberg says:

    I just had cataract surgery on my left eye. My vision is now totally blurred (as if I’m seeing through an opaque glass) My surgeon has diagnosed this as a corneal pressure problem and has prescribed travaprost ophthalmic solution 0.004% and says it should clear within a few days.
    Can this condition be caused by undue pressure from the post-operative bandaging? I was in a lot of discomfort when I got home after the surgery, and was only relieved after I removed one layer of the bandaging over my eye.

    • Morley:
      The patch can scratch or irritate the eye. This would be relieved somewhat by removing the patch. It sounds like you have the additional issue of high pressure that created swelling in your cornea.
      God Bless,
      Gary Foster

  10. I took my friend for her post cataract surgery visit. She states she will never have that surgery again. She is an avid reader. Her pressure was 48. After many eye gtts. and drinking glycerine, she remained in the Dr’s office for 3 1/2 hours. She also states they used a needle the size of an insuline syringer to the eye and asked that she return 2nd day post op. Is this a common issue?

    • Debbie:
      I am sorry your friend had these problems. Around one out of twenty patients have pressures in the forties, usually the lower forties, after cataract surgery. Generally, it is easy to get the pressure lowered with pressure drops and or a simple release of some fluid from one of the surgical incisions. It would be unusual to need glycerin or a needle to achieve good pressure. It sounds like your friend had both high pressure and a resistance to the normal easy methods of lowering and controlling the pressure.
      It sounds like her doctor was very conscientious through the entire process.
      Gary Foster

  11. Hello Dr. Foster,
    I have a dear friend that is about to have eye surgery for her cataracts on both eyes. She also has torn corneas. She’s scheduled to do the right eye first to repair the cataract. During the pre-op consultation though, it seems that the doctor is having a hard time coming up with a solution on how to protect the left eye after surgery on the right eye, while waiting for the surgery on the left eye. He says you can’t wear glasses after the surgery and, if she wears a contact lens on the left eye, she could damage her cornea more. Are there any solutions as to how to protect the left eye while waiting for surgery after the right eye has been done? (FYI: She used to wear contacts all the time, but has had to wear glasses and use eye drops and gel the past couple months in order to get her eyes ready for surgery.)
    Any thoughts would be appreciated.

    Blessings,
    Nancy M.

    • Nancy:
      The problem your friend’s doctor is trying to solve is called anisometropia. It occurs when the two eyes have very different prescriptions. If one eye has had cataract surgery and the implant is set for distance vision, but the un-operated eye is very near sighted, then objects would look big in the operated eye and small in the un-operated eye. This can be disconcerting. This is not noticed if a contact is worn in the un-operated eye, but the surgeon doesn’t think it is safe for your friend to wear contacts anymore. Potential solutions include make the two surgeries closer together so the time of imbalance is shorter, leaving the eye nearsighted so the two eyes aren’t that different from each other, wearing a contact anyway and taking the risk, or just suffering through the time when the two eyes are not well matched taking care to avoid circumstances where there could be safety risks like climbing ladders etc.
      God Bless,
      Gary Foster

  12. Hello,
    I am 67 years old and had a cataract removal surgery a week ago. My pressure was 25 before which was very good because before I had 27. I also have pseudoexfoliation in this eye (left). The surgery went fine and I didn’t have any complications that day. I was prescribed Prednisolone Acetate Suspension 1% that day and saw my doctor the other morning. My vision was very bad and the pressure in that eye was 52. He gave me some drops for 3 times and it went back to 25. I am taking both medications Prednisolol and Timolol 0.5. He wants it for a month. Is it safe for such time? Thank.

    • Asya:
      Pseudo-exfoliation can cause glaucoma. Your eye pressure was higher than normal before surgery and spiked up quite high after surgery. I usually use the steroid drops for two weeks after surgery. If there is extra inflammation, I will use the longer as you have described. We monitor the patients to make sure that it is safe and that the pressure doesn’t go up further with extended use of the steroid.
      God Bless,
      Gary Foster

  13. Wickramarathne G.T says:

    After cataract surgery my mother facing a big problem due to high eye pressure after 8-9 months from surgery too.what can we do? Is it never mind if she face for another cataract surgery to her other eye under this condition. Please kind enough to send reply to my email too.

    • Wickramarathne:
      If the pressure problems persist, a consult with a glaucoma specialist could be considered. This could also help with planning for cataract surgery for the second eye to help prevent the same problem.
      God Bless,
      Gary Foster

  14. sangita jain says:

    After having cataract surgery, eve pressure is not reducing.
    Doctors are suggesting about another surgery in which they will change the lens.
    Please give me some advice on this.

    • Sangita:
      The ideal position for a lens in in the capsular bag (behind the iris). In more difficult surgeries, the surgeon will sometimes place the lens in front of the iris (anterior chamber lens). This can raise the pressure in some patients. Do you know where they placed the lens implant?
      Gary Foster

  15. Larry Collister says:

    Doc –
    I’m 52 and had surgery for a detached retina on St. Patrick’s Day of this year. The detached retina was caused by a blow to my head on my hand on a sidewalk while running. A cataract has now formed. Surgery is scheduled for mid-Dec. The diopter difference between the surgically-corrected left eye and the unaffected right eye will be approximately 8 diopters. My opthamologist tells me that I’ll likely have to have a contact and eyeglasses to even things out in my brain to process what each eye is seeing. He’s also said I might still have issues using both a contact and eyeglasses. Finally, my right eye is too healthy to have cataract surgery covered by insurance. My optometrist, who referred me to this opthamologist, suggested that I the lens placed in the left eye match the current vision of the right eye – thus, all I would need would be glasses. Then, when I have cataract surgery in 20 years, I can get the right eye to match the left and still wear glasses. I have no issue w this suggestion as I’ve worn glasses since second grade. My opthamologist is pressing to have the left eye be surgically-corrected as best as possible. This route doesn’t seem to account for my total vision. Is there a medical reason not to have the left eye surgically-corrected to match the right eye and wear glasses? Are there any other options?
    Thanks and Happy Thanksgiving,
    Larry

    • Larry:
      Sorry for your eye troubles. Matching the right eye is a good option and it is the most conservative option. If you are fine with glasses for distance at the level you have always used them then this option would be a fine choice. There is no medical reason to not choose this option.

      If you have a desire to be less dependent on distance glasses, then the other options become worthy of consideration. Many patient want to see at distance with little or no glasses so they see the cataract surgery as a way to help one of the eyes towards the goal while they are already correcting the cataract.

      As you have described, if you set your left eye for distance, then you would have to wear a contact in the right eye to avoid anisometropia (objects appear different sizes between the two eyes). Another option commonly considered is having LASIK or PRK on the right eye to avoid wearing a contact lens.
      God Bless,
      Gary Foster

  16. Dear Dr,
    Afriend of mine went in for a cataract operation. After the follow up he dr wasnt happy and sent her to a specialist, in return he was not happy and operated immediately as the pressure dropped. After which she wen back for follow up then pressure went over 50. Dr wasnt happy, then put her on drops to lower the pressure. Tomorrow s he has to go back to him and if the pressure did not come down enough, he wants to operate again(3rd time). We just dont know what is next. Please help with some vital information. Thank you Jeanette

    • Jeanette:
      I don’t have all the information it would require to accurately answer your question. It may be that the wound was not watertight at first. If this happens, fluid can leak from the eye resulting in a lower than normal pressure. If this is true, then the second surgery was to suture the wound closed to make it watertight. Once the wound wasn’t leaking anymore, the pressure could rise, but rose way above normal.

      Hopefully, your friend’s pressure was lowered by the usual eye drops used for this. If pressure cannot be lowered by eyedrops or pills, in very rare circumstances, glaucoma surgery can be done to lower the pressure.
      God Bless,
      Gary Foster

  17. I’m curious if you might be able to answer my question. I’m nearly 27 now recently received an IOL implant after 27 years aphakic due to congenital cataracts (awaiting my next surgery for implant). They chose the AcrySof IQ (yellow tinted lens) – for the first two weeks I had light sensitivity and corneal edema and then the weeks after it was like I was looking through yellow glasses in my right eye. I am now on my fourth week, pressure as they mentioned is somewhat high but nothing to concern myself over..but I still can’t see purple in the right hue (it’s more towards brown or red). It is also somewhat hard to differentiate between blue and green and the yellow post-it note on my white stove is hard to see from the stove. Have you ever heard of anything like this? It isn’t all over..it’s just the central part of my vision..but in the peripheral everything seems fine. My surgeon is stumped..and my next surgery is soon but I’m worried about this problem.. it seems to have gotten better in the last week but I don’t know if it will completely go away.

    • Stephanie:
      The amount of blue blocking the Acrysoft lens is intended to match about the amount of blue blocking that a 21 y/o has in their natural crystalline lens. As such, most view this amount of color change as natural and normal as opposed the garish hue that colors can take with the completely clear lenses. The color is thought to reduce the chances of macular degeneration and there is evidence that it decreases night glare.

      There are rare and scattered reports of individuals with way above normal color perceptive abilities noticing color aberrations with the implant or color differences between eyes if they have a clear implant in in eye and a high energy blue blocking lens in the other eye. I set on a panel a few years ago where a few of these cases where presented at the American Society of Cataract and Refractive Surgery meeting.

      These individuals are often attracted to the fields of art or design because of their color abilities. These issues usually settle out with time, but in rare cases a lens exchange to a different color of lens implant can be considered.

      God Bless,
      Gary Foster

  18. Carla Wiggins says:

    I have a close friend who has glaucoma. She recently had the stents placed to reduce her eye pressure. She is about a week post op from the procedure and is experiencing a “fogginess” in her vision. Is this normal after this procedure? she states that each day it seems to be improving but her vision appears foggy.

    • Carla:
      With surgery, the cornea swells a bit. Corneal swelling makes vision blurry. As the corneas clear the swelling it is like defrosting a windshield and the vision clears. Given the fact that the vision is clearing each day, it sound like this is what is happening for your friend. She could confirm this with her eye doctor to be sure.
      God Bless,
      Gary Foster

  19. I had my catarct surgery for Left eye 1 year back. After surgery from day one I am having hazy and foiggy vision , where I had a perfect vision and pressure before surgery. The Eye pressure is consistently high , Macular edema also formed after surgery. The fogginess surprisingly is fluctuating , and I start with heavy fogginess in morning which slightly gets cleared towards evening and night. For Macular Edema ama Eye pressure lots of laser and injections have gone through without changing pressure and vision. 5 months back Our eye doctor operated Trab surgery to release pressure. After surgery for one week the pressure was less than 13 though there was no change in vision status. Yesterday in spite of having 3 Pressure reducing drops and two drops for inflammation along with Dimox tablets Pressure is still 32 to 34. Doctor is telling that cause is due to inflammation and eye pressur. During cataract surgery my eye was implanted with AC lens as Doctor says the cataract was very hard. Could you tell what exactly could be problem and whether it is curable?

    —-krish—–

    • Krish:
      I am sorry you are having these problems. Your original surgery was more complicated that usual so an anterior chamber lens had to be placed. This usually means the posterior capsule broke. If any pieces of cataract fell to the back of the eye, they can raise pressure if they are not removed. Probably this is not the case. A trabeculectomy was performed, but due to all of the inflammation from surgery, it scarred closed and the pressure went back up. Your surgeon probably had to use steroid drops to try to prevent the scarring, but if you are a steroid responder, it would have made it harder to keep the pressure lower. I do not know if mitomycin was used with the trab to try to prevent scarring. A second opinion from a glaucoma specialist often is helpful for consideration of potential options like a tube shunt to better control the pressure.
      God Bless,
      Gary Foster

  20. Hi Doc,

    Last summer my mother had surgery in both eyes for cataracts. Having problems with high pressure, the doctor started her on eye drops, twice a day. She has had eye infections and 2nd operations due to the pressure still hitting highs.

    Today she when for a checkup with the surgeon, only to be informed that the pressure was back to a high of 30 and that this doctor was now concerned and requesting more surgery to figure it out. He also told her that the infections are not gone and that she needs infection drops on top of the daily pressure drops.

    I need a second opinion. What do you recommend or what do you think we should do?

    Thank you,

    Jim

    • Jimmy:
      I am sorry your mother is having these problems. Many patients benefit from a second opinion with a glaucoma specialist if pressure problems are not responding to standard methods of controlling pressure. Retinal specialists are often consulted if there are any concerns about infection. If is quite rare to need additional surgery to control pressure, but can be a blessing when it is needed.
      God Bless,
      Gary Foster

  21. I had cataract surgery in both eyes 5 and 1/2 weeks ago. My interocular pressure before the surgery was 20. I saw the surgeon 1 week after surgery, and he told me everything was looking good. I saw an optometrist the other day to get fitted for glasses (I didn’t get 20/20 from the surgery) and he noted that my pressure was elevated to 28. I have been prescribed and taking Prednisolone AC 1%–one drop in each eye four times each day for the first five weeks after surgery, followed by two times each day for two more weeks after that. I just recently changed over to one drop in each eye two times each day. After learning of the elevated pressure from the optometrist, the surgeon has subsequently contacted me by phone and instructed me to continue with the drops two times each day for one week, then come to see him two weeks after that. My questions are: (1) I am diabetic with very slight diabetic retinopathy. Is a pressure of 28 safe, if hypothetically it has been elevated that way for several weeks? (2) Neither the optometrist or surgeon has mentioned infection or other complications. Am I right in assuming that the optometrist and surgeon are treating this as a side effect of the Prednisolone, and expecting to see a drop in pressure by the time of my next appointment? (3) Should I schedule a glaucoma consultation right away–or is it safe to wait the three weeks with a possible continued elevated pressure of 28–until I see the surgeon again? Thanks.

    • Joe:
      The most likely cause for the late onset pressure increase is the steroid use. A pressure of 28 is not alarming in a patient with otherwise healthy optic nerves. You do have the extra risk factor for weathering high pressure of diabetes. I usually do add a glaucoma drop as an extra protection in the 28 range though many would do fine without it.
      God Bless,
      Gary Foster

  22. I am 67 years old and have high pressure in both my eyes 24 and 28 and mild to moderate cataracts. Per test from two ophtamologist and a cataract/glaucoma specialist/surgeon said I have NO damage to my optic nerve or my eye. The specialist/surgeon told me I have ocular hypertension. The specialist recommended using Latanoprost for the pressure. The specialist also said I had spikes in my cataracts and would need them remove earlier. Do I need to have cataract surgery soon and do I need to take the drops to lower my eye pressure? All my life I have always felt I have had high pressure in my eyes, do to having a great deal of allergy sinus problems. Thanks.

    • Jackie:
      I can only comment based on what you have told me. There are patients that measure a high pressure on our machines, but actually don’t have high pressure inside the eye. These patients don’t develop glaucoma. There are other patients with high pressures that do have high pressure inside the eye, but have eyes that are more resilient to high pressure so they don’t develop glaucoma. Others have the high pressure and no visible damage, but with longer follow-up, eventually show damage (glaucoma) from the higher pressures. Deciding whether to start drops if there is no damage is a judgment call based on your family history, your overall health, how worried your are about damage, and how worried your eye doctor is about damage. You will need to make this decision with your eye doctor. If you are not comfortable with his/her advice, you could seek a second opinion with a glaucoma specialist.
      Cataract surgery often lowers the intraocular pressure a bit. Most seek cataract surgery when the cataract starts to affect their vision and their life.
      God Bless,
      Gary Foster

  23. Hello,

    My father had cataract surgery a year ago. Yesterday he went to the optician and found that his intraocular pressure was 31. He has many “floaters” since the cataract surgery and the optician believes that the trabecular meshwork has been clogged by debris from the operation. He is going back to the optician for more tests on Monday to determine if nerve damage has occurred. Could the iStent possibly be recommended for such a case as my father’s?

    Thank you for your consideration

    • Amy:
      Sorry your father has such high pressure. We don’t generally think of glaucoma coming from “debris” after cataract surgery. An istent is one potential option to treat high pressure. The istent is currently FDA approved for implantation at the time of cataract surgery, but does not have a code for implantation after cataract surgery. I know that doesn’t make sense, but that is CMS and government medicine in 2015 (not bashing, just explaining :)). The way this is handled does vary a bit deepening on which region of the country where you live so it is worth asking a surgeon that does the procedure in your area about the billing for an istent in the circumstances you describe.
      God Bless,
      Gary Foster

  24. Zeinabnoor:
    Currently your doctor is presuming that you have steroid induced glaucoma. Patients with this diagnosis require regular intraocular pressure checks over the first few years to prove that the pressure does not return. Over time, if the pressure remains low and the optic nerve remains healthy, the frequency of visits can be decreased as the doctor becomes surer of the diagnosis. If a steroid responder is put on steroids again, later in life, it is a good idea to increase the frequency of the intraocular pressure checks again.
    God Bless,
    Gary Foster

  25. My husband has recently had cataracts removed on both eyes (one week apart). The second is now post op 1 week. He saw the surgeon yesterday for a follow up and the surgeon noted the pressure was increased slightly but told him not to worry. He gave him 2.5 ml of Combigan to put in both eyes 2x a day – 12 hours apart. He also discontinued the Zymar drops in both eyes but wants him to continue with the prednisolone drops in both eyes 4x a day. Last night we administered the Combigan for the first time before bed and after waiting 5 minutes we administered the prednisolone drops. This morning he has woken seeing a white haze in both eyes. The white haze is not visible to me looking at him – but it is white hazy vision he is experiencing. I am afraid to put any drops at all in this morning! Up till now he has been amazed with the clarity and colour of his vision. Today we are concerned and cannot reach our surgeon as he is in surgery all day. Would love your expert advice! Thank you in advance!

    • Joyce: It could be something as simple as dry spots on the cornea, but in the early healing period it could be any number of more concerning issues. If vision is decreasing it is wise to persist until you can be seen by your surgeon or see another eye doctor in the same or another office if necessary if you can’t connect with your current doctor.
      God Bless,
      Gary Foster

  26. I just had cataract surgery and post op visit showed my eye pressure to have increased to 22 from 19 prior to surgery. I had eye pain when placing the to bracing drop in my eye and itching afterwards. My surgeon doesn’t seem concerned. What is opinion?. I am borderline open angle glaucoma.

    • Kathy:
      Normal eye pressure is 10-21 mmHg. In a patient with normal optic nerve health, I would generally not be concerned with a short-term rise to 22. In a patient with compromised nerve function I would pay more attention to the 22. Your eye doctor is the one that understands the level of concern he/she has for your nerve resilience. You mention borderline COAG. I understand this to mean that your doctor is watching you to decide if you have glaucoma. If this is the case, then it usually means that the doctor is not overly worried about your nerve health, but just keeping a closer eye on it.
      God Bless,
      Gary Foster

  27. Dale Pudloski says:

    A friend had cataract surgery a year ago. Since then he has had several bouts of eye pain (like the eye is being squeezed) and a bloodshot eye. His surgeon has told him this is not a problem but it has reappeared several times. Your opinion, please.

    • Dale: It is important for your friend to differentiate between an eye that looks red because the blood vessels are dilated which would indicated inflammation vs. a sheet of blood under the conjunctiva (white part of the eye) which would indicated a broken small blood vessel which usually occurs because the eye has been rubbed during sleep (subconjunctival hemorrhage.) The best way to resolve this would be for your friend to see the eye doctor the day it happens the next time.

      Most small problems resolve on their own without every being fully diagnosed and without treatment as the body has miraculous healing powers. Small and seemingly inconsequential problems obviously draw more attention if they worsen, but they also become more worthy of careful attention if they go away only to return later over and over again.
      God Bless,
      Gary Foster

  28. I am a normal pressure glaucoma patient with confirmed vision loss. I am also highly mi-optic. I had vitrectomies with cataract surgery L eye April 2014 and R eye June 2014. I did not have a gas bubble placement. I have history of anaphalactic shock on NSAIDS so was only treated with prednisolone after those surgeries. I was on prednisolone for months and months trying to get my retinas to return to normal- they were swelled up very high and refused to return to normal. Then they discovered from a visual field test that I am a steroid responder so I had even more vision loss. So they stopped the prednisolone but the retinas were not normal yet and once again swelled up to such a state that I now have central vision blindness from macular degeneration. The docs think I can recover some of that central vision if they can get retinal swelling down. SO I have been back on prednisolone for over 4 months again with more documented blindness happening from that. My retinas will not stay normal off the pred. We tried some other meds via injection and they failed. I had a canaoplasty in the L eye in Dec to try to lower pressure but it failed. I cannot stay on the pred as it is making me go blind from glaucoma damage and I am going blind from macular swelling if I don’t treat that. The docs are at a loss and I am desperate. Any ideas? ()I am on max glaucoma drops).

    • JJ:
      I am sorry that you are having so much trouble with your eyes. You had a vitrectomy and happened to have your cataracts removed at the same time. This is a very different and more complicated process than standard cataract surgery. You didn’t mention what eye problem had caused them to do the vitrectomy in the first place. Either way, your complicated pathway has been made much more complicated by the fact that you can’t tolerate the normal treatments since you are violently allergic to the NSAIDS and your pressure rises with the steroids. They attempted another injection (possibly Avastin) but it didn’t help. As a result you are left to use the steroids and to then manage the higher eye pressure they cause in you. You have had a canaloplasty attempted, but it did not work. It is likely that you are already seeing a glaucoma specialist since the canaloplasty you referenced is a procedure usually done by glaucoma specialists. If your are not seeing a glaucoma specialist, then you would likely gain additional insights from seeing one. They have other possible procedures that can be very effective at lowering pressure when medical management wont work like trabeculectomies and tube shunts. If the IOL could be controlled with a tube shunt for example, it would allow more liberal use of the steroids to control your macular swelling problem. I do not perform tube shunts, so you would need to discuss the risks, benefits, and alternatives with your surgeon.
      God Bless,
      Gary Foster

  29. Doctor Foster
    I had cataract surgery on my right eye 2months and have had no problems whatsoever. I than had cataract on my left eye two weeks ago and right after surgery I could see great. The next day my Doctor poked my eye to release fluid as my eye pressure was up. After 4 days a cloudiness started over my eye. I went back and the Doctor started me on Gambigan, twice a day and lowered the prendesone to twice a day. After 4 days my eye is no better and I see my Doctor tomorrow. I am 75 years old and do not want to have the Yag procedure done because of a possible retina displacement possibility. Is there another choice to fix this problem, such as staying on drops of some sort? I hope you can help me. Thank you.

    • Sandra:
      I am sorry that your second eye is healing slower than the first one. At your post op visit your doctor could let you know why the vision has worsened. There are a myriad of potential causes and many of them can be improved. Some of the causes cure themselves, but there are some that only resolve with prompt treatment, so finding out the exact nature of the problem is important.

      If eye pressure is still the problem, there other measures could be taken to augment the combigan drops you are using. Some patients develop corneal edema if the pressure is quite high. This would feel like a cloud over our vision.

      Problems with the posterior capsule usually do not develop this quickly.
      God Bless,
      Gary Foster

  30. Mary Henderson says:

    Hello,
    I need your expert advise. I had tube-shunt surgery for glaucoma on Jan. 22, 2015. Prior to this surgery I never new I had any condition such as glaucoma and I was evaluated as having not only open-angle but closed angle glaucoma as well. (I spent a week in the hospital for COPD and a strain of the flu for which I was taking lots and lots of steroid breathing treatments). My right eye started to blur and so an MRI was ordered but there were no abnormalities found. I had some vision loss because of pressure excelling to 53% before the surgery . Along with the tube-shunt implant I also had a cataract removed and a lens replacement all during the same surgery. I have healed well and pressure is stabilized. 18-20. I do prednisolone 1.0% once a day and I also do one drop of Travatan once a day. How long is a safe measurement of time to continue on these drops? During the course of my healing time I was also prescribed Atrophine four times a day for five days and then was instructed to discontinue use. When I read about this eye drop, it was not to be prescribed for glaucoma even though I was told to use it after my surgery. When I asked further questions regarding this issue I was told that it was prescribed for only certain types of glaucoma. I believe that it has something to do with the muscle control of the eye. Can you verify any of this?

    My other major concern is that while my surgery eye (R) is on the mend, my Glaucoma Dr. is recommending a lens replacement in what I classify as my good eye, (L) She states that I have open-angle glaucoma in my good eye and that she is afraid the I would have a closed-angle attack at any time. She states that my cornea is 6-9 mil. and that by replacing the lens that would then be reduced to 1 mil. which is safer for the natural water flow on my eye and that would drastically reduce the possibility of a tube-shunt surgery in my good eye for a while. Do you agree with this assessment? I have to use a magnifying glass to read small print but my distant vision is fine. I also have enough clarity in good eye that I feel it makes of for vision loss in my surgery eye. I now see a haze over everything with my surgery eye. I am not sure what a secondary cataract is . I am very reluctant to say okay and go with the lens replacement in my good eye. I am now experiencing ghost images in my good eye as well as distorted vision when I look at peoples eyes whether in person or while watching tv. I am very scared because of diplopia. I cover my good eye and the ghost images go away and I no longer have any distorted vision. It is all coming from my eye (l). I don’t know what decision to make about my good eye. I would like to know how you view my condition.

    Your response is greatly appreciated.

    Sincerely,
    Mary

    • Mary:
      Sorry for all the extra eye challenges you are having. The lens inside the eye gets thicker each year we are alive. As it thickens, it narrows the angle between the cornea and the iris where fluid leaves the eye. If the thick natural lens is removed (cataract surgery) and a thin intraocular lens is placed it will often allow the angle to be more open. On the first eye, the angle had closed and may have even scared closed. As a result, a tube shunt was used to keep the pressure lower. On your second eye, if the angle is already very narrowed, you doctor is hoping to get the thick cataract lens out and the thin implant in before the angles closes and scars. If successful, they are hoping to avoid the need for and the potential complications of the tube shunt.

      The atropine drop dilates the pupil and opens up the angle. It is common to use this drop after tubeshunts and trabeculectomies to keep the angle open in the first week or so after those surgeries. This is particularly helpful if the pressure is very low in the first week.

      Doctors tend to use the predforte as long as necessary to prevent the tubeshunt from scarring up, which would make it stop working.

      I have blog post on secondary cataract, which is generally a very small issue and easy to fix compared to the weightier glaucoma problems you are facing.
      http://www.garyfostermd.com/seconday-cataract-surgery-for-yag-eye-laser-starburst-vision/
      God Bless,
      Gary Foster

  31. Dr. Foster,

    I’ve learned a lot reading your article and the recent comments. Thank you for taking the time to maintain this thread.

    My daughter developed cataracts at 11 months and had cataract surgery at 12 & 13 months with IOLs placed. Her pressures increased and she was put on Timolol and Travatan. She stayed on them for about a year. At the year mark, we encouraged the doctor to wean her off to see if they stayed low and they did. The earlier higher pressures were then assumed to be the result of the steroids.

    She is now 3 & 1/2 years old (a year and a 1/2 later) and has been having her pressures have been continuing to stay low until the last appointment where they were 27 & 28. She’s now on Travatan and a mix of 3 (sorry don’t recall them all at the moment).

    When we were on the year of drops, our ophthalmologist simply said that after cataract surgery in children, glaucoma can develop and they don’t know why. She encouraged us to reconcile ourselves to the fact that she would be on drops her entire life.

    We were so relieved when she was found to be a steriod responder, but now we’re dismayed at the prospect that she could simply have glaucoma and be on drops her entire life again.

    Anyway – sorry for the lengthy story here. I have a few questions:

    Do you know of any other factors that could have increased her pressure like this?

    We’ve noticed also that she had “eye goupies” on the edges of her eyes leading up to the appointment. She gets these when she gets sick or has allergies. Could this be contributing?

    Another thing to note is that once she had been on the gloucoma drops for a day or so, the “eye goupies” disappeared. Hence, we were thinking maybe the increased pressure caused them.

    Thanks again – any insight you could lend would be wonderful.

    Tom

    • Tom:
      Sorry your little one has had so many eye adventures. Fortunately she was born in an era, in a location, and to parents that make treatments available her.

      In adults, cataract surgery tends to lower the intraocular pressure once the eye is healed. In children, sometimes glaucoma develops after the cataract surgery. I do not know if this is because the same factors that caused a cataract so young are also responsible for causing glaucoma or if the fact that children heal so much more aggressively makes the effects of cataract surgery bring about the glaucoma. There are other secondary causes of glaucoma that come from systemic health conditions. Usually, there are other signs and symptoms to alert your eye doctor and pediatrician to the presence of such problems.

      I do not know of an association between eye allergies and “goupies” and intraocular pressure. The eye drops are probably moisturizing the matter and rinsing it away rather than curing it, but you would need to ask this question to your eye doctor that has the advantage of examining your daughter.
      God Bless,
      Gary Foster

  32. Hi Dr. Foster,

    Thanks so much for the quick response – what you said makes sense. Great point about the eye drops simply rinsing her eyes out.

    We saw her ophthalmologist yesterday and the Dr. was very happy to see that her pressures were at 12 & 13. She said that meant the drops were working and daughter was doing great. We were told to stay on this regimen. Our next appointment is in 3 months.

    My hope is that whatever triggered the spike in pressure goes away. However, with the appointment being 3 months from now, is there a danger of it going too low? Are there any indicators I could look for?

    Our doctor’s attitude last time was that my daughter had a life long condition and that we just needed to keep on the drops forever. It took some persuading to get her to be willing to try her off of the drops for 2 weeks. Once we were off, she realized that my daughter was just a steroid responder.

    So – I’m afraid that now she’s going to simply assume it’s again a life long condition and not even try her off the drops.

    What would the pressures need to be at for the doctor to realize that there isn’t a problem anymore?

    Thanks again,
    Tom

    • Tom:
      Glad the pressure is down. If the pressure trends on the low side of ideal, doctors usually start eliminating the drops, changing to weaker drops, or decreasing the frequency until they find just the right combination. If the IOP stays low on minimal therapy, then a day could come where a trial without drops could be again considered. That is really glaucoma therapy 101 and a fairly normal course of action for doctors. Having said that, most need the drops long term.
      God Bless,
      Gary Foster

  33. Yvonne Gillham says:

    Hello Dr Foster,
    My 85 y.o. father had cataract surgery last Thursday prior to Good Friday. They gave him 3 injections around the eye before the procedure. His eye is black and he’s had a lot of pain but because of the Easter holdays he didn’t see an optometrist until Tuesday. His pressure was 40 and they prescribed 2 types of drops and this morning his pressure is 30 so it is coming down. The problem is he can’t see out of it. Is this a normal occurance? He had his other eye done a couple of years ago and that was no trouble and he could see the next day. Mum also 85 had cataract surgery on her eye and was able to see properly straight away. We are all very concerned that dad’s vision may be permanently impaired. All he can see is shadows. What are your experiences and thoughts about this? Thank you for your time and expertise, Kind Regards, Yvonne

    • Yvonne:
      I am sorry your father is having these troubles. It sound like his doctor uses a retro-bulbar block for anesthesia. I quit doing that routinely about twenty years ago. It gives a good anesthesia but can cause a black eye. http://www.garyfostermd.com/anesthesia-for-cataract-removal-surgery/

      If the pressure goes up after cataract surgery as it did in your father it can make the cornea swell. This causes blurry vision. If your father’s blurry vision is from corneal edema then this does clear over time in almost all cases. The edema makes it take a bit longer for the ideal vision to settle in. There are other potential causes of blurry vision after cataract surgery. Your eye doctor could let you know if he/she suspects any of these.
      God Bless,
      Gary Foster

  34. Margot Lowe says:

    I had an Express shunt about five years ago, and the pressure has maintained at about 10 mm. Now, I need to have a cataract removed. My concern is that in the cataract removal process, some of the debris from phacoemulsification will clog the Express shunt. Do you know if clogging the Express shunt has been a problem with phacoemulsification? Are there any other cataract surgery techniques that would be better for a patient with an Express shunt?

    • Margot:
      Your concerns are valid. There is always some inflammation in the eye after cataract surgery. The express shunt is metal and will withstand the process, but the tissues just outside it are vulnerable to scaring in the face of inflammation. This could decrease the flow of fluid through the shunt. Highly experienced cataract surgeons tend to perform the surgery more efficiently and potentially with less trauma to the eye. In addition, some surgeons would use the anti-inflammatory drops for a longer period of time before and after the surgery to decrease the chances and the impact of inflammation.
      God Bless,
      Gary Foster

  35. Hi Dr. I had my cataract (right) eye surgery in Jan this year. Prior to that I had Ahmed valve implant to reduce my high eye pressure. My vision on my right eye has been very blur – like seeing through multiple layers of wax paper before cataract surgery and got worst over time. After cataract my vision is still the same. Blurry. It is worst in the morning and slight better as day progresses. My doctor says I have corneal edema. So I am on istalol once in the morning and durezol every 2-3 hours. I was referred to a corneal specialist confirming corneal edema. My cornea thickness is 8 mil. My left eye (good eye) cornea is 5 mil. Corneal specialist recommended Muro 128 solution 3-4 times a Day and the ointment once before I sleep. Despite these vision is till the same. I.e. If I only rely on my right eye I will be considered legally blind and cannot drive. It’s my left eye helping me with my vision. It has been 3 months. 2 weeks ago my corneal specialist injected some steroids into my right eye in the hope it can do the work 24 hours to reduce my cornea inflammation. But to day it’s still the same. No improvement. Doctor said I may has posner syndrome. He is deferring possible corneal transplant while awaiting my eye healing response to the injection. So my question is (1). Is it normal to continue using those eye drops at such high frequency indefinitely ? (2). Was the corneal inflamed due to improper surgery induced when I had the Ahmed implant surgery and/or cataract surgery? (3) is there any way we can check and be certain the endothelial cells are damaged thus requiring a corneal transplant? (4) of the corneal transplant is to proceed will the transplanted corneal last or will the inflammation flare back up as a result of the hermetic virus which the doctor. Is suspecting? Thanks in advance.

    • Ken:
      Sorry your eyes are giving you so much trouble. If you have high eye pressure it would make it harder to keep the transplanted graft clear. Efforts to solve that ahead of a transplant would make success more likely.

      It sounds like your doctors are considering several different diagnoses for your troubles: 1 Posner-Schlossman Syndrome or 2. herpetic virus. Usually inflammation makes the eye pressure go down and there are only a few conditions where inflammation makes the pressure go higher. The two diagnoses you have listed are a couple of those on that short list. If the problem is from one of the herpes viruses (cold sore virus or the chicken pox virus) it is something that could reoccur in a transplant graft. Fortunately there are some good medicines to help keep this in check.

      If there is inflammation at the root of eye troubles, then often there is no recourse but to use the eye drops for a longer period of time.

      The corneal edema is worse in the am because during the day your eye is open and some of the fluid causing corneal edema (swelling) can evaporate directly into the air. At night, this happens much less since the eye is closed. The Muro 128 has a high salt content so it pulls water out of the cornea.

      The corneal edema and the corneal thickness is usually enough evidence of endothelial damage, but you can do a cell count test (Specular Endothelial Micrography) that takes a picture of the endothelial cells. This allows a doctor to count how many cells you have per square millimeter and to study the shape differences of the endothelial cells.

      Your eye was already at increased risk for endothelial troubles prior to the cataract surgery based on your advanced glaucoma and the previous eye interventions you had before cataract surgery. You would have to ask your surgeon if your cataract surgery was more difficult than average.
      God Bless,
      Gary Foster

  36. sue williams says:

    Thank you for this web site, I just had surgery and went back for my post op visit . My doctor said i had elevated eye pressure, To be honest i did not fully undersytand her explaniation of the problem causing this but now I do . Sry for my bad typing

  37. Joan Lim says:

    Dear Dr Foster
    I am a glaucoma patient and my IOP has always been controlled between 14-16
    3 weeks ago I had a right IOL implant (cataract)
    1st and 3rd day post op the IOP was 22 and 28
    3rd week post op was 36 and I am now receiving DorzoComp-Vision (dorzolamid/ timolol) eyedrops. 1st hour after application the IOP was 28 which is today.
    I have noticed that my eyesight was better 1st few days post op than now. When my IOP is controlled again, vision should be improved.
    What do you think?

    • Joan:
      You will need to ask your doctor these questions to know for sure, but if you are a steroid responder, the pressure often goes back to your baseline within a couple months of stopping the steroid drops. If you have corneal edema from the higher eye pressure and that is the cause of your blurry vision then you could anticipate a return of better vision when the corneal swelling resolves.
      God Bless,
      Gary Foster

  38. I had cataract surgery in left eye ONLY on 2/12/15, before surgery eye pressure was @18 L and 20R. After surgery and during using drops (vigamox 4xs day for 1 week only, also Keterolac & Prednisol 4x’s day for 21 days then 2x’s a day for 2 more weeks) pressure went up even in the other eye 25L and 27R so Dr. started me on Timolol both eyes…pressure dropped to 15L & 16R but Dr. wanted me to keep using the Timolol . During this time my OP eye became cloudy and blurry…told to stop the Ketorolac and pressure rose again to 16L & 28R (28 in my non surgery right eye). Now 1 month later using Timolol in right eye only eyes are clear 14L & 19R. Dr. wants me to use Timolol forever in my right eye…My question can I stop the Timolol and see if my eyes go back to normal on their own and monitor the pressure before my system gets dependent on Timolol? If so how can I wean off of it safely. Without a heart rate and blood pressure jump.

    • Rodney
      We usually don’t have to slowly taper the timoptic when it is time to stop it as so little gets into the blood stream. The bigger question is when or if it is a good time to stop the timoptic. The principles surrounding this decision include how strong are your optic nerves. If they have significant damage then we are less comfortable about stopping drops to see if the IOP is fine without them. If the nerve has full strength then it is less risky to try. Your eye doctor is the one with information to best counsel about the wisdom of such a trial. Another consideration is your family history. If you have first degree relatives with glaucoma, it would be more likely that your IOP rise is genetic rather than solely related to your recent surgery.
      God Bless,
      Gary Foster

  39. I had cataract surgery yesterday an when being released was given one rather large capsule of Diamox …why was I given that drug. Was told it was for fluid. What exactly is that drugs useage. Thank you, Dr Foster..
    BRichtmeyer

    • Betty:
      Diamox is a drug that lowers eye pressure. Some doctors give this drug routinely to all of their patients to decrease the chances of high pressure after cataract surgery while other only use it in patients at a higher risk for high eye pressure.
      God Bless,
      Gary Foster

  40. Carrie Carlson says:

    Hi Dr. Foster,
    My husband, 41yr old with left glaucoma since teen years due to unknown eye trauma, recently had spike in early April IOP of 52. No optic nerve damage yet, on cosopt, alphagan p, and Xalatan for 10 years. Started on Diamox when IOP was 52. Came down to 40s, had dislocated lens (trauma), surgeon did IStents and intraocular lens 3 weeks ago.
    Question…can Ilevro cause increase in IOP? He is a steroid responder. Pressure recently was as high as 62. Doc drained some fluid, dropped down to 6. Started Besivance antibiotics. Pressure back up to 22, while on Diamox 250 TID, and max drops. They were talking tube shunt, but IOP dropped to 6.
    Can Besivance cause increase in IOP? Thanks for your input. I love your website and Q and A info. Extremely helpful! We love our Ophthalmology team by the way, and completely trust them.

  41. kelly c says:

    Sept of 2014 i had cataract surgery in my right eye, in all follow up visits i had high pressure, i was never told why, and my anxiety levels were extremely high, i would burst into tears at every visit, eye taps seriously freaks me out.after 2 months of visits every 2 weeks i quit going, missed work.now i feel pressure behind my eye and its sore to touch. What should i do?

    • Kelly:
      Sorry for your troubles. Your recovery is not the norm. You may want to consider a second opinion, possibly with a glaucoma specialist.
      God Bless,
      Gary Foster

  42. I have been diagnosed with cataract in both my eyes. As i was given steroid injections twice for asthma, the doctor has diagnosed it as steroid induced cataract. I am 46 yrs old.Though the doctor said it did not require any immediate surgery, since it is affecting the quality of my life, i would like to go in for surgery. The doctor also found that my optical nerve cup was large. But the OCT and eye pressures are normal. Will the steroid drops i need to take after surgery affect my optic nerves?

    • Great question John,
      If your pressure went up back when you were taking steroids for asthma, then it would likely rise again after cataract surgery if you stay on the steroid drops for an extended time. If your eye doctor is checking your pressure regularly, he/she would detect and rise and initiate pressure-lowering drops to protect your optic nerves.
      God Bless,
      Gary Foster

  43. Sunil kumar says:

    Hello Doc,
    My mother had cataract surgery for both eyes about three months ago.
    But pain in both eyes still persists 24*7.
    Doctor said that both eyes are fine and there was no problem in operation .
    I hope you could give us the possible reason for the continuous pain and possible remedies for the pain.
    Thanks

    • Sunil: I am sorry your mother is having these problems. It would be very very rare to have ongoing pain in both eyes. It is possible that you would benefit from a second opinion to find out if the intraocular lenses are in the correct position and the make sure there is no ongoing inflammation.
      God Bless
      Gary Foster

  44. Fred Berryman says:

    My husband had cataract surgery Tuesday and his pressure was dangerously elevated the next day. Since then he’s been taking five different droops. His pressure was lower on Thursday, but the eye still appears swollen. We are schedule to fly on august 1 on a series of planes, and on august 8 on a commuter plane. Is it safe for him to fly? Thank you.

    • Kay:
      Sorry the pressure is running high. If there is no gas in the eye and the pressure is normalized by the drops, then usually flying would not be an issue. You will need to get specific guidance from your eye doctor for your husband’s case. A secondary issue that you would be traveling away from your eye doctor before your husband’s issues have settled. Your doctor should weight in of the risks of this and may be able to help you arrange follow-up at your destination.
      God Bless,
      Gary Foster