Questions & Answers

Studies have shown that consumption of caffeine causes transient elevation of eye pressure in patients with glaucoma and ocular hypertension. Additional population studies report higher intraocular pressures in glaucoma patients who regularly drink caffeinated beverages as compared to those who do not. Thus, most glaucoma doctors recommend avoiding heavy consumption of caffeine.

Lexapro has not been reported to have any direct effect on eye pressure. Lexapro and other antidepressants do have anticholinergic properties which may affect patients with narrow-angle glaucoma. Valium is an anxiety medication that also can have anticholinergic properties and should be used very cautiously in people with narrow-angle glaucoma.

Many systemic medications can aggravate dry eyes. However, not many systemic medications can cause glaucoma. Corticosteroid medications (prednisone) can cause elevated eye pressure. Drugs with anticholinergic properties can increase the risk of narrow-angle glaucoma attacks in patients with anatomic narrow angles. Such drugs include some antidepressants, antihistamines, stimulants, and others. You should specifically ask your eye care provider what drug may be causing both your dry eye symptoms and possibly glaucoma.

Scleritis is generally considered to be an autoimmune disease, and can be associated with other such diseases. However, while some researchers suggest that immunity may play a role in some forms of glaucoma, there is no overwhelming evidence that autoimmunity plays a causative role in primary open-angle glaucoma, the most common form of the disease in the United States. In an eye with scleritis, glaucoma is most likely to result when the inflammation of the sclera extends to the trabecular meshwork and aqueous humor outflow pathways of the eye. By increasing resistance to aqueous outflow, this inflammation, or the scar tissue it causes, produces elevated eye pressure and, eventually, glaucomatous optic nerve damage. While anti-glaucoma medications may be effective in this form of the disease, all treatments must include aggressive management of the scleritis, or underlying inflammation. This generally involves systemic medications that would be prescribed by an internal medicine doctor, and possibly a rheumatologist (an internist who specializes in treating autoimmune disorders).

Open-angle glaucoma can cause visual field defects. Brain tumors can also cause visual field defects if they affect any part of the visual pathway. Usually, visual field defects that arise from glaucoma fit a specific pattern, whereas visual field defects that arise from conditions such as a brain tumor have different characteristics. Additionally, there should be other signs on ophthalmic exam which may help distinguish whether vision is affected by glaucoma or from the effects of a brain tumor. Your eye care provider should be able to address your concerns. Your oncologist should be able to recommend whether or not a repeat scan of your brain is indicated at this time.

Xalatan and Enalapril used together should not interact to cause side effects. Xalatan is a prostaglandin analog that lowers intraocular pressure. It does not have major systemic side effects. Enalapril is an angiotensin converting enzyme (ACE) inhibitor that is used for blood pressure control and for some cardiac conditions including heart failure. Enalapril does not affect intraocular pressure. You should contact your physician(s) and pharmacist for more detailed information concerning the medications that you are taking and their potential interactions.

The treatment of angle-closure glaucoma depends on the type of glaucoma present. Chronic angle-closure glaucoma involves scarring of the pathway to the drainage tissue of the eye with resultant elevated eye pressure. This type of glaucoma is treated with laser surgery, eye drops, and sometimes with glaucoma filtering surgery and cataract removal. Anatomic narrow angles refer to the anatomical configuration of the anterior chamber of the eye where the pathway to the drainage tissue of the eye is restricted. A prophylactic laser iridotomy creates an alternate pathway to the drainage tissue of the eye and prevents an attack of acute angle-closure glaucoma. This laser procedure has minimal side effects that are well-tolerated by most patients, including mild inflammation, which is treated with a short course of anti-inflammatory eye drops, and potential for mild visual disturbance (a line of light in the peripheral vision). Other potential side effects that are rare include retinal detachment, corneal damage, and cataract formation. The success rate of this laser treatment in preventing angle-closure attacks is very high. Some patients may have a component of another type of glaucoma (open-angle glaucoma, phacomorphic glaucoma, chronic angle-closure glaucoma, or plateau iris, for example) that requires further monitoring and treatment after the laser procedure. Thus, need for follow-up with your eye care provider after the laser is necessary.

The treatment of glaucoma involves the reduction of the intraocular pressure to a target level where there is no further damage detected. Usually, this target level should be 30-50% lower than the pressures at which damage occurred. Your description of your husband's optic nerves indicate that his anatomy (small, tilted optic nerves) may make the detection of early damage more difficult, and the assessment of worsening of disease difficult as well. However, the treatment for his glaucoma will still involve reduction of the eye pressure. If treatment with one medication does not lower the pressure to the target level, additional medications can be added, and/or laser or glaucoma filtering surgery can be performed. It is also important that other causes of optic nerve damage are ruled out (vitamin deficiencies, optic nerve tumors, ischemic optic neuropathy, rare infections). A second opinion with a glaucoma specialist may be beneficial in order to determine optimal treatment and prognosis.