Elevated intraocular pressure

After many months of treatment for post-operative macular edema with Pred Forte drops, the pressure in that eye went up into the 20's. I went on Cosopt and over the next couple of months, the pressure was in the 30's. My doctor did not trust the instrument and made no changes. Last week, I saw a different doctor who was much more alarmed that the pressure was 38 even on Cosopt. He added Alphagan and wants to see me back on Monday. I do have visual phenomenon like seeing swirling spots of light alot, but no pain. They both say my optic nerve looks healthy. How concerned should I be about all this? Since I have had CME for a long time, my doctor is considering an intravitreal steroid. How worried should I be about this? Is it known why steroids raise the intraocular pressure and should be be reversible after steroid therapy is stopped?

[Sandy Feldman, MD, MS]

Dear BHS1,

These are good questions to ask given your history of intraocular pressure increases.  Your eyeMD will be able to advise you further about the risks given the high pressure on topical steroids.  It will be important to lower the pressure.  Are you also using a topical nonsteroidal anti-inflammatory to treat your cystoid macular edema.  

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California