Long term eye drop use

[Ritualhazard]

Hello folks.

Does anyone have experience of long term usage of multiple eye drops please?

I’m going back to see my consultant next week to review the results of the SLT from a couple of months ago. While my pressure still seems to spike at high twenties it hasn’t gone above that since the procedure so in a way it seems to have worked. However, I’m still taking Latanoprost, Dorzolamide and Brimonidine twice a day to maintain my pressures generally in the low twenties.

I’m starting to get a good selection of side effects; sensitivity to bright lights, headache, tinnitus, facial (and sometimes whole body) flushes, general aching in the eye area particularly around the sinuses.

I have read that people start to develop long term intolerance of some drops. If I do then I’m in trouble as in my consultants words there is nothing else.

Any experiences you can share would be very helpful when discussing my future and the next steps.

Thank you!

[Trish_GlaucomaUK Partner]

Hello Ritualhazard,

Doing punctal occlusion after you put your drops in can help reduce the risk of side effects.

Once you put your eye drop in, close your eye and press gently on the tear dut for up to 2 minutes. This should be done on each eye individually, rther than waiting until you have out both drops in.

If you havent tried this yet, please do.

Some patient information leaflets show diagrams on how to do this. Not all do, but we always recommend you do it with whatever drop you are prescribed.

If drops don't work, or the person experiences side effects that can't be tolerated, the consultant will look into other options. As you have had laser already, which was successful to a degree, it may be repeated but if not, your consultant will discuss surgery.

[Ritualhazard in reply to Trish_GlaucomaUK]

Thanks. I do the occlusion thing - I even time it for two minutes to be sure I’m doing it for long enough. Guess it’s when the side effects out weigh the risk of surgery.

[Hidden]

I'm surprised that your consultant should say 'there isn't anything else'. There are several other operative procedures which are indicated if you are intolerant to or insensitive to the eye drops. If he/she continues to say this I would ask your GP to send you for a second opinion.

[Ritualhazard in reply to Hidden]

Thanks. I meant medically not surgically. He’s very clear there are multiple surgical options but it’s the when we need to decide.

[Hidden in reply to Ritualhazard]

Ah right.I've had pressures in the low twenties for some time and SLT which didn't work for me. I can only take brimonidine as all other drops cause systemic side effects..... respiratory.

The decision to do surgery on one eye.... cataract removal and goniotomy.... was taken a few months ago because the pressure had risen to 33 and stayed there and there was considerable thinning of the optic nerve although my vision is perfect. It was felt I was on the brink of losing some vision in that eye. Fortunately it appears to have been successful....pressure now 16. The other eye remains stable.

I don't know if this helps with decision making.

[Ritualhazard in reply to Hidden]

Thank you. That’s helpful. Like you I don’t have any vision loss yet but I’m starting to show signs of damage on my right optic nerve. Interesting that you had proactive surgery, I was wondering if they would wait until there was definitive damage before taking action but your experience shows not. Appreciate the reply

[Hidden in reply to Ritualhazard]

I guess it depends how much thinning there is.... it had reached a fairly critical stage in my right eye and increasing. Left eye much less so and stable.They certainly didn't leap into operating, it was all very measured and thought out.

[Peg99]

Hi Ritualhazard,I have been on various eye drops and combinations of drops for 37 years. I have normal tension glaucoma and need to keep my pressures below 10, and yes, some did lose their effectiveness over the years but I was simply switched to another drop, or had a new drop added to the mix. Good old Timolol has been with me since the start but I really can't remember all the different drops I have tried. As a general rule, the combination drops have not worked at all for me so following Trabeculectomies in both eyes 37 years ago I have drops and diamox capsules. I am currently on Timolol, Brimonidine and Latanoprost and those, with the diamox are working fine for now.

I too have had Consultants that say that if the drops don't work they're stuck, but in reality, they have always come up with another drop for me to try, even if it has been a different drop from the same family of drops - eg Travaprost instead of latanaprost. I'm sure they could do the same for you if the need ever arises. And remember, there are new advances being made all the time, when I started on this road, most of the drops we all use now didn't exist. So there is always hope

😀Good luck to you and keep taking the drops...

[Redshoes15]

HiRitualhazard. I was on different combinations of eye drops for 17 years with my pressures well controlled. Then they suddenly stopped working as apparently your body gets used to them and the pressures creep up. So I have now had two trabeculectomies which so far seem to have worked.

[Ritualhazard in reply to Redshoes15]

Thank you. That’s my concern