Blunt trauma to the eye while playing badminton(follow-up to another question)

[AmanGrover]

So I posted earlier too about my condition, which you can read here -

https://www.medhelp.org/posts/Eye-Care/Is-traumatic-mydriasis-permanent-/show/3027938

Now it has been 3 weeks since my injury, and I have been visiting my opthalmologist regularly every week. Today he checked my eye pressure which he measured to be around 28mm Hg, still very high. Although, he says the RBCs in my eyes have decreased a lot, still the pressure is high because the injury and swelling is still there. He says there are ways to surgically removed the blood, washing the eyes, the term he used, but he says the procedure won't necessarily work, the RBCs will come again if the injury is not healed which will heal over time. My medication includes Diamox tablet thrice a day, Oxytocin 50 mg (to be taken 30mg in morning and 20mg at night). Eye drops include Pred forte 4-6 times a day, brimo twice, Dortas-T thrice and homide twice.

Now since I have been taking Diamox regularly for 2 weeks now, my BP has drastically dropped to 60-65, which is very worrisome for me. I have even lost 2 kgs of weight over these 2 weeks, started feeling very weak. I just need to ask if the taking this medication for 2-3 more weeks (as said by the doctor) will have any permanent adverse effects to my health? (I went to my physician also, he said the effects shouldnt be permanent as such, but the medication is indeed strong). Secondly, is this the right way to go? I mean waiting for the injury to heal itself(as he said when the injury gets healed, the pressure will come to normal, the priority here is keeping the pressure of the eye low).

Thankyou.

[JohnHaganMD]

You have a very serious problem and your personal physician and your ophthalmologist need to confir.  Your low blood pressure is likely due to the Dortas-T which has a beta blocker in it. Beta blockers can cause all sorts of side effects including low blood pressure, slow pulse,  severe fatigue, exercise intolerance, cold feet, even trouble breathing and wheezing.   Diamox is a miserable medicine and often causes decreased appetite, tingling in the toes and fingers, weight loss  and inability to taste beverages.  So your medicines likely are causing a lot of your problem. Which, if any, could  stopped I’m not sure.  Dorcas T has dorzolamide in it which is called a CAI and so is diamox And normally you don’t use two carbonic anhydrase inhibitors.  You need to see if your ophthalmologist can stop some of your pressure medicines.  

[AmanGrover]

Thanks for the response. I made my physician and my opthalmologist converse this, and the Opthalmologist says they have to keep the eye pressure low, so no change in medicine, just that Diamox has been reduced from 3 times a day to 2. And the physician has guided my how I can keep my BP normal, by taking lots of fluids and sodium. Opthalmologist says they will continue the same medicine for 2 more weeks.

[JohnHaganMD]

You are in for a long, miserable 2 weeks.

[AmanGrover]

Well, my BP has come back to normal for now. I just need to ask one more question, how long does it take for the RBCs to completely be gone from the vitreous humor? My Opthalmologist says minimum 2-3 weeks, maximum no one can tell for sure. And he says the increased pressure is due to the RBCs only, which has caused glaucoma.

[JohnHaganMD]

When blood gets in the vitreous it’s ‘isolated” and can stay there for many months even indefinitely. The RBC’s eventually die and dissolves.  The average life of RBE is 3 months.  But the remains of the RBC can stay in vitreous and in some cases have to be removed with operation called vitrectomy. This is done often in diabetics that have blood in vitreous.  Also there me be blood in the front chamber of the eye (hyphema) ask your Eye MD if you had a hyphema. Lastly the glaucoma can come from the blow to the eye. “Traumatic glaucoma usually with angle recession” and thus even if the RBC’s do dissolve you could have permanent glaucoma.   As I said previous other things you are at risk for besides glaucoma: retinal detachment, cataract, macular damage,  epiretinal membranes.

[AmanGrover]

Yes, the MD says I had Hyphema also(what other complications can arise due to Hyphema?), and I have been going for checkups regularly, and he says it the amount of RBCs have decreased but may still take 3 more weeks.

[JohnHaganMD]

Don’t mean to be pessimistic but no way you can predict what your eye will look like in 3 weeks.  Besides all the other delayed and immediate complications a hyphema  increases significantly the risk of traumatic glaucoma, can cause the lens of the eye to come lose in the eye (phacodonesis/dislocated lens) and blood staining of the cornea.

[AmanGrover]

He said 3 weeks is the minimum time period, how much more it can take no one can tell. And he was thoroughly checking the lens the last time I visited him, and he says it doesn't look like any damage to the lens has occurred. So, in short there is a long way to go for my eye to be normal again(aside from other complications like weak eyesight etc)?  I was a very active person prior to my injury, I went to the gym regularly and played badminton a lot. How soon can I resume with my sports activities without risking any further damage to the eye?

[AmanGrover]

Since the MD has advised me not to do any strenuous activity for now

[JohnHaganMD]

Only your ophthalmologist can advise you on activity.  Wearing eye protection work and sport specific is something you must do for the rest of your life.