Eye Pressure and Glaucoma

My mother is 81 yrs old and in very poor health from cardiovascular disease and kidney disease.  She recently developed high pressure (40) in her left eye due to a very large cataract.  She does not have vision in her left eye and it is too late to correct with cataract surgery.  The eye surgeon has given her drops (one of which, comigan,  is having serious effects on her blood pressure and pulse) but the pressure has been reduced to 10.  The surgeon is now talking about cryosurgery.  I do not believe she can undergo any type of procedure well, so I asked why we could not continue to treat with drops to relieve the pressure.  He stated that her eye would burst.  I have read several articles and most state that the eye will not  burst but rather damage to the optic nerve will occur.  Since she has already permanently lost the vision in this eye what will it matter if the optic nerve is further damaged?  I need advice.

[John C Hagan III, MD, FACS, FAAO]

You should very seriously consider the Eye MD surgeons recommendation. Combigan has a beta blocker in it and it can cause serious side effects including severe slowing of the pulse, wheezing, chronic cough or sinus drainage, profound fatigue, etc. It's likely that her other physicians will want the medication stopped.

As a rule IOP of 40 due to hypermature cataract cannot be controlled with medication. There is something worse than a blind eye and that is a BLIND AND PAINFUL EYE.  And there is where these often end up.

Yes the eye can rupture or "explode". I have seen one case and written it up in a medical journal. Most are neglected glaucoma cases. The one eye saw was an older male in his 80s with an eye blind from glaucoma that did not take medications or go to the Ophthalmologist. He had severe pain that was releived when he heard a loud pop then found parts of his inner eye on his cheek. Technically this is called "spontaneous, external expulsive hemorrhage".

The cryotherapy is not like tradional surgery and involves no cutting, sewing and is usually done in the office rather than a operating room.

It goes without saying to do every thing you can to preserve sight in the "good" eye.

JCH MD

[kay1124711]

I have read that cryotherapy is painful and that infection and inflammation may follow.  Is there something better than this option?

[John C Hagan III, MD, FACS, FAAO]

I can't tell you. It doesn't always cause pain, inflammation is inevitable, infection is rare.  That approach is like saying "I'll never get in an automobicle because I've read that tens of thousands of people die in them every year."

Diccuss with her Eye MD

JCH MD