Eye drops unpleasant, but part of glaucoma treatment

ON CALL

March 08, 1994|By Dr. Simeon Margolis | Dr. Simeon Margolis,Special to The Sun

Q: My eye doctor has just started me on eye drops for glaucoma. He warned me that there can be some side effects, but I have forgotten what they are. It may not be a side effect, but putting the drops in my eyes twice a day is not a pleasant prospect. Can't I take some kind of pill instead?

A: Glaucoma damages the optic nerve and leads to a progressive loss of vision if untreated. In most cases glaucoma is due to increased pressure within the eye (intraocular pressure or IOP). Glaucoma cannot be cured and prevention of optic nerve )) damage requires lifelong treatment.

In the most common type of the disorder, known as open-angle glaucoma, eye drops, pills and surgery are directed toward lowering the IOP. In this country, eye drops are usually the first treatment for glaucoma. Pills and surgery are generally considered only when people have serious side effects or respond poorly to medications, have medical conditions (such as severe heart or lung disease or high blood pressure) that preclude drug therapy, or do not take their medications properly.

The side effects from topical medications for glaucoma depend on which of the three types of drugs are used; and they can affect the eyes, the rest of the body or both. Local side effects include burning, stinging, tearing, itching or redness in the eye. Systemic side effects, such as an abnormal heart rate, asthma and low blood pressure, can occur because a substantial amount of the drug placed in the eye is quickly absorbed into the body.

Patience is required to keep medications confined to the eye. Because the surface of the eye can hold only a small amount of additional fluid, liquid medications tend to overflow and run down the face where they do no good. Also, the fluid remaining TTC near the eye drains quickly into the nose through a small duct at the inside corner of the eye. Medications that enter the nasal passages can be absorbed into the rest of the body. The following measures can help keep eye drops where they belong:

* Lie down to take eye drops.

* Place the drops in the middle of the eye.

* If the prescription calls for several drops at a time, wait five minutes between each drop.

* Use a finger or a tissue to gently press the inside corner of the eye to close the eye and block the nasal duct for a few minutes after each drop.

Carbonic hydrase inhibitor pills lower IOP effectively but intolerable side effects (numbness or tingling, weakness, loss of appetite) and occasional serious complications (kidney stones, blood abnormalities) limit their utility.

It is important for you to use your eye drops as prescribed or to tell your doctor if you are unable or unwilling to do so. Noncompliance with eye drops is a major reason for continued progression of optic nerve damage. Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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