Science & Research

Thank you for your question. This darkening of the eyelid skin is a known side effect of the medication and is mentioned in the prescription medication insert included with every bottle of Lumigan. This warning reads as follows:

"LUMIGAN® (bimatoprost ophthalmic solution) 0.03% has been reported to cause changes to pigmented tissues. The most frequently reported changes have been increased pigmentation of the iris, periorbital tissue (eyelid) and eyelashes, and growth of eyelashes. Pigmentation is expected to increase as long as LUMIGAN® is administered. After discontinuation of LUMIGAN® pigmentation of the iris is likely to be permanent while pigmentation of the periorbital tissue and eyelash changes have been reported to be reversible in some patients. Patients who receive treatment should be informed of the possibility of increased pigmentation. The effects of increased pigmentation beyond 5 years are not known."

It sounds as though you are having increased pigmentation of the eyelids from the use of Lumigan. As they mention, this is reversible in some patients if you stop the medication. If you have a change in the color of the iris (i.e. the colored part of the eye), this may be permanent. You should speak with your eye doctor about the side effects that you are noticing and discuss whether or not you should continue the medication. Do not stop the medicine until you have discussed this with your doctor, however.

Thank you for submitting your question. The use of steroids, such as flucinonide cream, can be associated with increased intraocular pressure and glaucoma especially if it was used around the eyes or it got into your eyes. Unfortunately, without having examined your eyes before you started the fluocinonide cream and again after you used the cream, it is impossible to determine if the cream was the direct cause of the increased intraocular pressure and glaucoma. Once a thorough eye exam has been completed, your eye doctor will likely set a target or goal intraocular pressure. If your doctor has set your goal intraocular pressure lower than 18 mmHg, then I would not suggest stopping your glaucoma medications and waiting to see if the glaucoma progresses. However, if your doctor set your goal intraocular pressure to the upper teens, then monitoring for progression or an increase in pressure while you are off of the medications is reasonable.

Even though you have experienced side effects with one glaucoma medication, there are many different types of glaucoma medicines (with and without preservatives) that could be tried. If this does not work, you may need to consider either laser treatments or surgical methods to lower the intraocular pressure to the goal set by your doctor. Your eye doctor will then follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves after the new treatment is started. If there is evidence of glaucoma progression, then more drops, more laser treatments, or more surgery will be necessary to lower the eye pressure even more. If you are concerned that your glaucoma is progressing, it is also ok to ask for a second opinion from an ophthalmologist that has completed a glaucoma fellowship prior to trying laser treatments or surgery.

Thank you for your question. We do occasionally see an increase in intraocular pressure after eye surgery for various reasons, but often this is unrelated to the development of glaucoma if it occurs many years later. In general, glaucoma is usually seen in both eyes. It is possible that you simply have glaucoma in both eyes and it has not shown up in the other eye yet. If the glaucoma is only in one eye, your eye doctor should look for a cause. Without having examined your eye, it is nearly impossible to determine the cause of the glaucoma. Two of the main causes of either asymmetric glaucoma or unilateral glaucoma in otherwise healthy patients are pseudoexfoliative glaucoma and angle-recession glaucoma after trauma. If your retinal tear was caused by trauma or you have ever had trauma to the eye, your eye doctor should examine the drainage system for damage at your next visit. This can be done easily with a special lens called a gonioscopy lens. It is quick and easy to do.

Also, increased intraocular pressure seen at the same time that a retinal tear or retinal detachment is diagnosed is not uncommon. This is known as Schwartz-Matsuo phenomenon. The photoreceptors are the part of the retina that detect light. When a retinal tear or detachment occurs, the photoreceptors may be knocked off of the retina and get caught in the drainage system of the eye. This will cause an increase in intraocular pressure. However, this usually does not occur 3 years after the retinal tear is repaired. Finally, the type of procedure used to repair the retinal tear and how much inflammation you had in your eyes after the surgery could be related to the development of glaucoma. Often there is nothing that you could have done to prevent this, nor did any of the eye doctors do anything wrong in their treatment of the retinal tear. This could just simply be a side effect of the treatment that was necessary to fix the retinal tear. While we may never know the exact reason for your glaucoma or if there is any relation to your previous retinal tear, I suggest you ask your eye doctor if they can identify any causes. Sometimes simply knowing why the glaucoma has occurred is helpful for my patients.

Every patient is completely different. It depends on how advanced the glaucoma is and how much damage has been done to the eyes. As an example, immediately after a patient has eye surgery, I may see them 1-2 times per week until they are stable. For those patients with advanced glaucoma and uncontrolled intraocular pressure I may see them several times per month if we are making changes to their eye drops or we are considering surgery. Other patients that are glaucoma suspects or patients with mild glaucoma that has been stable for several years with no changes in intraocular pressure may be seen one or two times per year. Our goal as eye doctors is to identify glaucoma before you, as a patient, ever notice any changes.

Your eye doctor will likely follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves at different intervals to see if there is any evidence of glaucoma that presents in the future. The frequency of examinations will depend on how advanced the glaucoma is and how well you are responding to treatment. If you have questions or concerns, do not hesitate to start an open dialog with your eye doctor and ask them to explain why they have chosen the particular monitoring plan that they have prescribed for you. If you are still concerned, it is always ok to ask for a second opinion from a glaucoma specialist.

Thank you for your question. We do occasionally see an increase in intraocular pressure after eye surgery for various reasons, but often this is unrelated to the development of glaucoma if it occurs many years later. It is quite possible that the macular pucker surgery had nothing to do with the increase in eye pressure. However, without having examined your eyes throughout that period of time, it would be impossible to tell. Elevated intraocular pressure is a risk factor for glaucoma, but just because the pressure is elevated this does not mean you have glaucoma. Often people with elevated intraocular pressure alone, and no other signs of glaucoma, are given the diagnosis of ocular hypertension.

Similarly, just because the intraocular pressure is normal, this does not mean that someone cannot have glaucoma. I would suggest a thorough evaluation by a glaucoma specialist to determine whether or not there are other signs of glaucoma besides just an increase in intraocular pressure. If there are other signs of glaucoma, then you will likely need to be treated for glaucoma for the rest of your life. Your eye doctor will likely follow the intraocular pressure, vision, visual fields, and the appearance of the optic nerves at regular intervals to see if there is any evidence of glaucoma progression in the future.

In general, abuse of methamphetamines has harmful side effects all over the body and is never condoned by any health care professional. Detailed studies of long term methamphetamine abuse and glaucoma have not been done. However, methamphetamines and other stimulants are known to dilate the eyes. These drugs have been known to cause angle closure glaucoma attacks when the eyes become dilated. For this reason, some stimulant medications, like those prescribed to treat attention deficit disorder, must be used with caution in patients with a either narrow angles or a history of angle closure glaucoma. In addition, some glaucoma specialists believe that high doses of even mild stimulants, like caffeine, can increase intraocular pressure. Methamphetamines could also increase intraocular pressure in the same way.

Thank you for your question. I assume that when you say that you have tunnel vision and cloudiness in the right eye, you mean that you have advanced glaucoma that has taken most of your peripheral vision and is now affecting your central vision. It is not unusual to have good acuity (like the 20/20 vision you have in the left eye) but still have glaucoma. This disease tends to take away the peripheral or outside vision first and then cause a decrease in acuity in more advanced stages. Most people that have glaucoma have it in both eyes, but the severity can be different. The only variable that we can change to slow or stop the progression of glaucoma is the intraocular pressure. Once a thorough eye exam has been completed, eye doctors often set a target or goal intraocular pressure. To achieve this goal, there are essentially three different tools that we can use to treat glaucoma: medicated eye drops, laser treatments, and surgical methods to lower the intraocular pressure. The eye doctor will monitor the intraocular pressure, vision, visual fields, and the appearance of the optic nerves to see if the glaucoma progression has stopped. If the pressure is not reduced enough or the doctor ever notices advancement in the glaucoma, they will add more medications or use laser treatments or surgery to help lower the intraocular pressure further. The states have different laws concerning the level of vision (visual acuity) and the width of visual field (degrees of vision) needed to maintain a driver’s license. Your eye doctor will need to do a visual field examination and determine your visual acuity with glasses to determine if you meet your state’s requirements for a driver’s license.

Flashes of light, known as photopsias, are not usually associated with glaucoma. They can be related to the natural changes that occur to the gel (vitreous) in the middle of the eye or the retina. Often the flashes of light are nothing to worry about and are simply part of the aging process that the gel/vitreous goes through naturally. However, you should have a dilated eye exam by an eye doctor as soon as possible to make sure it is nothing more serious. When the vitreous is changing it can cause tension on the retina. In a few people this tension can cause a small hole or tear to form in the retina. If a hole or tear is present, this could lead to a retinal detachment. Any new flashes of light, new floaters, or the feeling like a curtain is coming over your vision from any direction can be a sign of a retinal detachment and should be examined by an eye doctor immediately.