Elevated Eye Pressure

[Keeping_healthy]

I recently went to get my eyes checked as I had broken blood vessels and the optometrist wanted to keep an eye on them every two months. Since being on prednisone for GCA, my blood pressure came back down and my blood vessels haven’t got any worse but now my eye pressure has gone up nine points to 19. I’m currently on alternate days of 5mg and 10mg from 60mg. Has anyone had this issue? And did it come down as you lowered the prednisone?

[DorsetLady PMRGCAuk volunteer]

Broken blood vessels are very common with Pred, but so long as they clear within a week nothing much to worry about - they just look unsightly.

Your pressures will invariably increase on higher doses, but they should return as you reduce - but they do need to be checked on a regular basis until such time as they are back within normal range.

Why are you on alternate days of 5mg & 10mg? Very strange regime, and not really best for your illness.

From previous posts I see you’re on Actemra - is that why your Pred is taken that way?

Don’t have personal experience of Actemra so would be interested if anyone on it explains.

[Keeping_healthy in reply to DorsetLady]

My rheumatologist has me on quite a fast tapering plan, in the back of my mind I wonder if this is ok as reading everyone else’s stories it seems they are going a lot slower, but then I think he’s the expert😬 I was on 60mg for a month, then I came down 10mg a week, then after I got to 10mg, he put me on 5mg and 10mg alternate days, which I will do for two weeks, then I will do 5mg until I see him the following week. I’m also doing weekly injections of Actemra. So far I’ve not had any major problems apart from the usual tiredness or ‘fuzzy head feeling’ and this usual goes in the afternoon.

[DorsetLady PMRGCAuk volunteer in reply to Keeping_healthy]

I know you can come down a lot quicker on Actemra - but it does seem very fast - especially for those in UK, where we’ve only been authorised to use that drug for about 18months so not that many on it.

Just monitor symptoms and obviously any cause for alarm get advice - hopefully you won’t need to.

[Keeping_healthy in reply to DorsetLady]

My rheumatologist said if I have issues I can just go up a bit, but so far so good! My biggest problems have been the dreaded moon face and weight gain, despite being Keto! And also having to socially isolate. When you take Actemra it lowers your immunity, so I’m being careful not to pick up any infections as you have to come back off it until you no longer have the infection.

[PMRpro Ambassador]

It is a known adverse effect of pred, especially at high doses. The normal range for eye pressures is usually taken as from 12 up to 22 so it is still fine albeit higher for you. If your pressure was 10 before that is actually on the low side.

The rheumy won't be THAT expert in using Actemra and tapering pred as it is barely 2 years that it has been used in GCA and GCA is a rare condition. But if it is working - that's what matters.

[SheffieldJane]

Elevated eye pressure is a side effect of Prednisalone. I have it too. I am awaiting the results of recent measurements and tests by the hospital Ophthalmologist . I am currently on 10 mgs of Entric Coated Pred each night and Tocilizumab once a week. I have PMR (4 years) and GCA 2 months. I can actually feel an unpleasant sensation of pressure when my eyes are tired. I am also hoping that this symptom will correct itself as I reduce Pred further. I am hoping that no news is good news, it’s been a couple of weeks since the tests ( Glaucoma).

[Dydee in reply to SheffieldJane]

I do have glaucoma and my Opthalmologist appt. last week showed that my usual 18 pressure with nightly eye drops had gone up to 26 on Pred. He has taken me off drops for 3 weeks and I will retest 3 times over the day when I go back Aug. 31. Hopefully it won't go terribly high while I wait. I think he is thinking about changing meds while I'm on Pred.

[SheffieldJane in reply to Dydee]

Fingers crossed for you Dydee.

[Dydee in reply to SheffieldJane]

Thank You!!

[Koalajane]

Not long after my PMR diagnosis I was at the eye clinic and told I had glaucoma and put on drops. At thE next visit to the eye clinic a more senior eye consultant measured my cornea and said they were thick and this had an effect in the eye pressure tests. At many of my visits to the eye clinic I have my pressures checked with different tests than the “puff test” and they do not seem to worry about it now

[Keeping_healthy in reply to Koalajane]

I have had the ‘puff test’ before, but this was a circular blue light, amongst other things, which she uses after I have had my eyes dilated. She said she would start to be more concerned if it went up to 21. So hopefully it will come down with the reduction in prednisone as it had gone up 9 points in 2 months to 19😬

[PMRpro Ambassador in reply to Keeping_healthy]

Raised pressures alone are not glaucoma - other criteria/measurements are involved. So it is important to have the checks and not forget ...

[Keeping_healthy in reply to PMRpro]

Yes, she has me going back in two months to re-check.

[DorsetLady PMRGCAuk volunteer in reply to Keeping_healthy]

The puff test is outdated now - the last couple of years I’ve been to my optometrist he’s used a device much as you describe. Tonometer is name of instrument.

[Koalajane in reply to DorsetLady]

The puff test is what the nurses do to check if I can have the O CT scan and if concerned they check with opthamologist before administering the dilating drops

[HeronNS]

To address the broken blood vesels - my ophthalmogist told me to use preservative free artificial tears when they occurred. This does seem to help them clear up much faster. 🤓

[Keeping_healthy in reply to HeronNS]

Good to know!

[Phoenix51]

Yes, this happened to me to. Never had any issues with my eyes but a few months after being on Pred for GCA I was diagnosed with high ocular pressure, glaucoma and cataracts. I was put on eye drops to reduce pressure but after 3 months the pressure was even higher. I was then put on a type of beta blocker eye drop, this didn’t work either - the pressure came down slightly but not enough and I still had haemorrhage behind my eye so I’m now on an additional eye drop twice a day. I go back in 4 weeks to see if this combination has worked. I have thin corneas apparently so they factor this in when calculating the pressure. I have been told that now I have glaucoma , even when I am low dose Pred I will still have it, it’s a life long condition apparently. Good luck with your pressures

[PMRpro Ambassador in reply to Phoenix51]

Raised pressures alone is not the same as glaucoma - for glaucoma there are other factors to take into consideration because the raised pressure has caused damage. The raised pressures alone usually do return to normal as pred dose falls, but once glaucoma is present, you are correct in saying it is lifelong.

[Koalajane in reply to PMRpro]

I think the consultant actually said to me that he didn’t think I had glaucoma just ,I think it was, ocular hypertension and then he measured my cornea

[whitefishbay]

I’m on 1mg pred for 2 years I think but glaucoma in one eye. As I understand it pressure needs to be under 25 so keep checking. Keep an 👁on it. I take 1 drop of latanopost (so?) nightly. My last 5 apts at Moorfields have been cancelled. The optician can tell you your eye pressure. Not sure if this is PMR related or just me. Best of luck.

[Viv54]

Hi , i have never had a problem with my eyes until i started on Pred ! Had my eyes checked a couple of weeks ago, high pressure in both eyes and the start of a cataract .Now waiting to see a eye consultant ! It seems to be a common thread on here. Have to admit i was gutted !

[Jackoh]

I did have the bleeding in one eye after a cataract operation. It did clear up but then I had it happen two or three more times- each lasting for about 1 week. My optometrist did monitor it very closely and my Consultant Ophthalmologist was not concerned. My eye pressures though were not high. I did use the eye drops for dry eyes more often and eventually it did completely clear up.

[Luciejc]

I have and glaucoma use 2 different drops and have twice been referred to a glaucoma a specialist for laser treatment to reduce the pressure. Now that I have GCA my Dr. is more vigilant than ever. It was recently 19 and was going to be sent back to the specialist if it went higher but fortunately it came down. As of this week my reading was 15 so I'm ok for now...on 7 mg of Prednisone and Actemra weekly.My rheumatologist has been involved with clinical studies of this biologic drug.

[Amkoffee]

I know that what you're experiencing isn't funny and is probably very scary but I have to point out the you made a pun whether it was intentional or not. You said that your eye doctor was keeping an eye on your eye!😊

[Bailybiscuit]

I developed glaucoma because of pred and had laser surgery which didn't work alone so had to have eye drops for the pressures. Your pressures are not too high yet but you need to keep having them checked .Mine were late 20's I think when when they did the laser surgery. I expect you have been told what to look out for, a dull ache in the eye ( it woke me up at night) and a halo around the lights.

[Keeping_healthy in reply to Bailybiscuit]

She actually didn’t tell me anything about what to look out for🤔

[PMRpro Ambassador in reply to Keeping_healthy]

Usually it is too late when there are symptoms - and that is why it is important to have regular eye checks for pressures at least annually but more often is better,

[Boss302Fan]

19? I can only relate my experience, I live in Maryland USA. But my optometrist would consider 19 good.

When I went to my optometrist for my routine annual appointment last year my right eye pressure was 21, but my left was 32. Fortunately, no internal damage, just elevated eye pressure. I was informed that their policy was to treat anytime pressure was greater than 27. She put me on Rhopressa 1 drop/day in my left eye with follow-up 2 months later. At that time my left eye pressure had reduced to 25. Since she is monitoring me every 3 months. The last time they had to switch me from Rhopressa to Timolol maleate 1drop 2x/day 12hrs apart due to Rhopressa not covered by my insurance. However, she indicated it is more effective. We will see at my next upcoming appointment.

I don’t know what the unit of measurement is for eye pressure or if our numbers are on the same scale.

I’ve also been on the lowest dose of anti-high blood pressure medication via my GP. Was told by both doctor’s that I’ll probably need to stay on both until my Predisone treatment terminates or possibly once I get below 5mg/d. Been on Prednisone since June 2019 started at 80mg/d initially now starting week 3 of simple taper to 5.5mg/d.

My Rhemy is staying out of these decisions.