Recently, I've had a condition that was first diagnosed as an eye virus and now as an eye allergy. I was put on a steroid-antibiotic called Tobradex Opthalmic, which provided some relief. However, the drug raised my intraocular fluid pressures to 36 and 38 respectively (I guess normal is about 8 or 10). Could my eyes have suffered permanent damage if this high pressure went on for two to three weeks before the situation was detected? When I realized I was having problems with the Tobradex, I returned to the eye doctor and he prescribed a couple of anti-glaucoma eyedrops, which brought the pressures down in a couple of days.

M.

Glaucoma is a condition in which the pressure within the eye is elevated. If untreated, it can damage the optic nerve and lead to blindness. Since the optic nerve is relatively strong, it can often withstand years of elevated eye pressure before damage occurs. However, once damage is done, it is irreversible.

When a doctor determines a patient has glaucoma, the patient will be placed on medications to lower the eye pressure, thus reducing or eliminating pressure damage to the optic nerve. Since glaucoma is usually a chronic condition, there will be times when the eye pressure may creep up and again cause damage to the optic nerve. Additional medications, laser treatment or surgery may be needed to stop the damage to the optic nerve.

There are a few situations in which the pressure in the eye can become elevated suddenly. The most common cause is the use of steroid eyedrops, with about 3-6 percent of patients who use steroid eyedrops developing glaucoma. For these patients, when the steroid drops are stopped, the eye pressure will usually drift back to normal. Occasionally, people who use steroids for years may develop permanent glaucoma. Recently, studies have also shown that the chronic use of oral and inhaled steroids can also elevate eye pressure. Patients on these medications need to have eye exams at least twice a year.

For a person who uses steroid eyedrops, a brief period of eye pressure elevation usually will not cause optic nerve damage. As you mentioned, Tobradex is an eyedrop that contains both an antibiotic and steroid. The use of this medication can lead to elevated eye pressure, such as you experienced. However, a brief course of glaucoma medications, along with stopping the Tobradex, will usually result in a normal eye pressure over a few weeks. Your ophthalmologist can examine your optic nerves and test your eyes with a visual-field test to determine whether any permanent damage has occurred.