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Ocular Pressure

trimt profile image
11 Replies

Has anyone suffered with high ocular pressure after using Steroid inhalers? I have been and my optician says I should try not to take any inhaled steroids!! But my asthma doctor says my asthma cannot be controlled any other way!!

Has anyone had a similar experience? I take 100/6 symbicort 1 puff per day

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trimt
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11 Replies
twinkly29 profile image
twinkly29

That's a ridiculous thing for the optician to say because with asthma inhaled steroids are the maintenance treatment.

I've had increased pressure in the past (caused by long-term oral steroids I think not the inhaled ones) and the opticians just saw me more regularly and kept an eye on it.

It looks like you're on a low ish dose anyway of Symbicort - although symbicort, like virtually all steroid inhalers, should be taken twice a day because they last about 12 hours. So I'm a bit confused about that - it might be worth discussing with your GP about a lower dose of something that's taken twice a day so it's appropriately balanced in terms of timing. In effect you're medicated for 12 hours and then not for 12 hours.

trimt profile image
trimt in reply to twinkly29

Thanks Twinkly! I am trying to keep the dose super low as I'm so worried about my eyes!! I've lost faith in my optician to be honest! Do you think symbicort is a potent steroid? I tried clenil and it didn't seem to work for me. And the fostair seems like a higher dose than the equivalent symb....thanks for your insight

twinkly29 profile image
twinkly29 in reply to trimt

The steroid in symbicort is just a different one to that in clenil and Fostair (they share the same steroid base). I wouldn't say any are more potent that the others, the dosages would be where it differs (the numbers aren't directly comparable though). 100/6 Symbicort is the lowest dose for that though. But you need the lowest dose to keep your asthma controlled (not symptomatic and not needing your relief inhaler) - keeping a dose low for other reasons isn't advisable and us potentially dangerous.

If you are truly well controlled on what you're on (and have been for 3 months or more) then it might be worth asking your GP if you could try a just-steroid inhaler (Symbicort has a steroid and a long-acting bronchodilator in it) - but it really still should be twice a day so they'd need to work out what's available vs what you're on now. Taking symbicort once a day just doesn't make sense to me as a prescription. If you don't need it more than that then perhaps treatment could be stepped down slightly (by a doctor) - but it may be you do need that level of treatment (which isn't high at all but taking it away might not be sensible).

Lysistrata profile image
LysistrataAdministratorCommunity Ambassador

I don't have this, but I'm very disturbed by the optician advising anything on your asthma treatment, especially 'try not to take it'. That is SO incredibly inappropriate and not their place to tell you not to take medication you need for another condition, especially one like asthma where not taking your preventer medication is dangerous.

Your asthma doctor is right, you do need to take inhaled steroids for your asthma, so please don't stop! The optician doesn't even know if it's related - I don't know enough about this area though I am aware corticosteroids can cause some eye problems. However, while possible, it seems unlikely that your low dose of inhaled steroids would be the culprit. I know people are different but my ocular pressures are fine and I am on high dose inhaled steroids and was on oral steroids for a while, so it isn't inevitable that steroids cause this - it could be due to something else entirely.

It's also worth bearing in mind that if you don't keep your asthma controlled with inhaled steroids, you're more likely to need courses of oral steroids which have more side effects, including for your eyes (again this isn't inevitable but it is more likely than with inhaled steroids, especially low dose inhaled steroids which don't have much if any systemic effect).

As Twinkly says, if the optician is worried about your ocular pressures then they should monitor that and make any referrals for it as appropriate. What they should NOT be doing (and this also applies if you needed to see an ophthalmologist etc) is tell you what to do with your asthma treatment. You could mention the ocular pressures to your asthma doctor as an FYI, but they can't really stop steroids which are pretty much the backbone of asthma treatment. However, it's worth them being aware so they can factor it in to any other treatment decisions eg if you needed more medication.

Poobah profile image
Poobah

Your inhaled steroid is quite low so it's unlucky that such a minute amount is causing ocular pressure issues. Some patients can react more sensitively than others. Like many asthma inhalers, Symbicort can raise blood pressure and cause eye problems and sometimes this is linked to low potassium levels, as the medication affects the patient's ability to retain normal potassium levels. Definitely get you blood pressure checked and seek treatment as necessary. You can also eat a more potassium rich diet to counter the effects of your medication. Definitely discuss your options with your GP as it's best to monitor this issue until the matter is resolved.

Rlbee1974 profile image
Rlbee1974

Hi just read your post and as an Optician myself and an asthmatic I know that inhaled steroids shouldn’t be enough to affect your eye pressures, normally the oral steroids can have an effect but not the inhaled ones. Ultimately you need to be able to breathe . If your eye pressure is high the optician should be referring you to the eye clinic not saying comments like don’t take your inhaler . I would speak to your gp and see what they say they may refer you to investigate or suggest you have another eye test somewhere else and ask them to refer you if necessary . There are 3 different things we look for when contemplating a referral and eye pressure is one of them so if the other two are fine it may just be ridiculous comment . Hope you get a sensible answer from the gp.

trimt profile image
trimt in reply to Rlbee1974

Thanks so much for that!! I have spent a year desperately trying to stop taking my preventer!! Wish I'd found this forum last year - I have even had iridotomy in both eyes now (last June). My pressure is currently at 17 and as my breathing is so bad, I have started to take my symbicort again (only since last week). I am having the pressure checked again in 3 weeks so hope it hasn't risen.

Rlbee1974 profile image
Rlbee1974 in reply to trimt

If you’ve had an iridotomy last year you must have been under the hospital then . Did they just discharge you after having that done . It sounds awful but take whatever you need to be able to breathe properly and feel well and the ophthalmologists will have to sort the eyes out with what happens. You need to be able to breathe properly . By the way 17 is good generally . If it goes up over the next 3 weeks but you can breathe nicely again ask to be re-referred to ophthalmology they can sort it . Hope you feel better soon

twinkly29 profile image
twinkly29 in reply to trimt

Also please speak to your GP as previously advised and sort out your inhaler - it should be taken twice a day (the one you're on) so maybe the GP can find a lower dose one to take twice a day which equates to what you should be taking now (but appropriately balanced). Not taking your asthma medication is potentially life-threatening.

trimt profile image
trimt in reply to twinkly29

I completely agree!! I've decided that gasping for air on a daily basis isn't a good move - especially during this pandemic!! Thanks so much, I really appreciate it😀

twinkly29 profile image
twinkly29 in reply to trimt

Glad to hear it 😆And good luck!

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