who, where, when

I am 57 years old and was diagnosed with thyroid cancer and narrow angles all in one month. I already have an inner ear condition-menieres.

The thyroid cancer will be further assessed in March (I had 2 malfunctioning parathyroids removed and at the same time a thryoid nodule in which was found papillary cancer- I still have 1.5 lobes remaining- wish they had been taken out the first go round).

Eyes- IOP was 17 OD, 16 OS by applanation tonometry. Slit lamp Exam was significant for lids w. meilomian glan inspissation and papillary reaction OU, corneas had pucntate epithelian erosions OU, anterio chamber was shallow OU. There was no cell/flare OU, iris was significan for no neovascularization OU, lens was clear OU. No dilated fundus exam due to risk of angle closure attack.

Do I need yag peripheral iridotomies, what are the chances of success, do I travel to the best specialist that I can find, how many iridotomies should they have performed to be an expert, how do I find the best surgeon for my condition, how long can I wait to find them and get an appointment ( how at risk am I now that I am using the pilocarpine drops TID), what about follow up if the surgeon is not local to me here in Texas? Stress- how bad for my eye condition?

I have been taking xyzal, one of the newer antihistamines, to try to help save my hearing. Although my pharmacist saw nothing about abstaining from xyzal use for patients with glaucoma on the package insert, I have to wonder about taking it. Xyzal has been very helpful for my asthma as well as my vertigo, since my asthma is triggered by allergies.

Actually I wonder if scuba diving is a risk right now because I have not had iridotomies yet? Is there a particular depth that is unsafe to go below because of the increased pressure? I am a technically deep dive certified diver.

[Houman Vosoghi, MD]

Go see a glaucoma specialist and if they agree that you have narrow angles, you should not delay in having the laser iridotomies done.  It is a very simple procedure that carries some small risks that your surgeon could discuss with you.  Any glaucoma specialist would have performed hundreds of these within their first few years in practice and it is a relatively simple procedure so as long as you get a good feeling from the glaucoma specialist you see, it should be fine.  I haven't heard of xysal being a contraindicated medication, but anytime you have narrow angles you must be careful with antihistamines as a class and weigh the risks and benefits of taking the medication.  Just have the laser done and be done with all of your concerns.  Chances of success are very high from the laser but there is still a risk of chronic glaucoma in the future so you must still be examined periodically afterwards.  Laser is meant to prevent an acute angle closure glaucoma attack which could be devastating to your eye(s).

HV

HV