Eye pain/Cosopt/Vision change

Following an episode of severe eye pain in my left eye, I was prescribed Tobradex, which I took almost a week.  Upon follow-up my ocular pressure in both eyes was very high (29 mmHg), but this has been brought way down (15 mmHg) with Cosopt.  We don't know if the elevated pressure was a response to the steroids or predated them.  The last time I had tonometry was 2003, when it was 20 mmHg.

Although the pain in my left eye is gone, I periodically feel small spasms in it.  Further, following the use of Cosopt, I have experienced a vision change in my left eye.  It seems to have become more myopic, but maybe a better description is that the force of the image seems to be slightly diminished.  Peripheral vision seems fine, though.  My ophthalmologist didn't think this sounded serious but suggested I could come back in to have a vision exam so as to compare new and old prescriptions.

I want to emphasize that neither of the ophthalmologists I saw found any corneal damage or any detectable difference between my two eyes upon inspection, and haven't treated them any differently.  But first the pain and now the vision change are specific to one eye.  Does anyone have any idea what the explanation could be?  There is some history of MS in my family, but I have not had any symptoms of that.

Thank you.

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

You likely are either a steroid responder or you have glaucoma or both. you need a complete glaucoma work up: visual fields, optic nerve OCT, gonioscopy, stereo disk photos, central corneal thickness measurements.

After this is done consideration can be given to stopping the cosopt and seeing where your IOP ends up. If its too high or the glaucoma tests are abnormal then different medications or glaucoma laser therapy SLT can be done.

JCH III MD