IOP of upto 50

[Mickyg18]

Hi all
My wife has SLE which about 8 months ago began to come undercontrol with mycophenolate. Subsequent to this she has had eye pressure increases and over a period of 6 weeks it got upto 56 in one eye though the other eye whilst initially high has returned to normal
She has since been taking 4 eye drops instituted one at a time had 2 SLT procedures and a iridotomy
Drops are alphagan adopt xalacom and pilocarpine
Each of these treatments has works as they were introduced but after a week or so eye pressure started climbing again.  Same story with each new treatment the most recent pilocarpine her IOP was 34 over a week came down to 25 two days ago was 36 again
Her neck hurts when her IOP is high and her symptoms vary so there is no consensus on even if its open angle or closed angle though thy think open angle
Anyone have any ideas or suggestions or dealt with this before she's been to eye hospital and seen opthalmologists etc but given i can't find record of a case like this anywhere I'm guessing they don't see them either!
Thanks for your help
Mike

[Mickyg18]

Thanks for that we have now been referred by our specialist to a glaucoma specialist
Thanks for your input
Mike

[Doreen Fazio, M.D.]

Your wife should be under the care of a glaucoma specialist.  Gonioscopy needs to be done to assess the drainage angle at the front of the eye; this will help determine if the angle is open or narrow, and if there are any adhesions (synechiae) closing the angle.  Also, if she is also on steroid eye drops, these could be elevating the pressure, and should be tapered once the inflammation has been controlled.  Surgery may be necessary if there is no other way to control her eye pressure.