1. < Eye Conditions

Difficulty tapering off prednisone in one eye after cataract surgery

Posted by pb50 @pb50, Jun 6 7:35am

I had bilateral cataract removal two weeks apart on April 19th for right eye and May 3rd for left. Following surgery there was a prescribed regiment of eye drops for antibiotic, NSAID, and steroid (Prednisone). The antibiotic was qid x 1 wk. The nsaid was qid x 2 wks. The steroid was qid x 1wk, tid x 1wk, bid x 1wk, and qd x 1wk.

The right eye did fine. Prednisone in the left eye should have stopped May 31 but is stubborn in tapering off . It feels swollen and hurts in the morning and periodically throughout the day. Ive kept it going every other day but that just means it hurts on the off day. My surgeon says the eye is healed and i seem to understand the principle of tapering so use my judgment. 🙄

Since I'm my own clinician here, has anyone experienced this? If it matters, the drops are Prednisolone 1%.

@dadcue I'm out of my element here.

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pb50 | @pb50 | Jun 7 2:12pm
In reply to @annebw "My ocular pressure also shot up, and I ended up with closed angle glaucoma. I think..." + (show)
@annebw

My ocular pressure also shot up, and I ended up with closed angle glaucoma. I think that is a possible side effect of prednisolone eyedrops. They put a shunt in my eye, which relieved the pressure and pain, but I am now blind in that eye.

Jump to this post

Gracious that is terrible.

REPLY
pb50 | @pb50 | Jun 7 2:28pm

@dadcue
All good today - tomorrow is Saturday. Which is my every other day prednisone day. Two scenarios -‘it hurts or it doesnt. If it doesnt, im going to let that ride. My cortisol may have kicked In. If it does…Other than An eye docs office, where could one get an ocular pressure reading if needed? ER?
If there isnt one I have two options..
* ’hit it with the pressure drops i used after surgery in case it is elevated pressure. If it helps call doc’s Emergency line.
* hit it with prednisone as planned and approved by doc
P
Ps..
Not asking you what to do.. just sharing my thought process and asking if you know where i might access an ocular pressure reading

REPLY
DadCue | @dadcue | Jun 7 4:28pm

I would think the ophthalmology office that did the surgery would have someone on call for any concerns you have.

I don't think your intraocular pressure (IOP) is the problem because your symptoms are relieved with the prednisolone 1% eye drops. Steroids increase IOP but not that much.

When my eye felt like it was going to explode it was within a few hours of going home after cataract surgery. High IOP can happen but it usually happens within 24 hours following cataract surgery and transient. I no sooner got home and I was calling my ophthalmologist with severe eye pain. I had a prescription for the pressure drops but I didn't have time to get it filled. I didn't even know my IOP had reached the critical threshold. My ophthalmologist apologized and said he should have put the pressure drops in before I went home.
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I'm personally not afraid to use prednisolone 1% eye drops. I've used them for uveitis and other eye problems. My very first uveitis was treated initially with steroid eye drops. I had instructions to call if my uveitis symptoms worsened otherwise follow-up was going to be 2 days later. I was calling in every day with worsening symptoms. They would increase the frequency of the steroid eye drops until I was up to hourly drops or as many as possible. My ophthalmologist gave up on the steroid eye drops. He said the uveitis was "aggressive" so he was going to hit it with 60 mg of oral Prednisone. He said I could still do the steroid eye drops for comfort as often as I wished. He wasn't too worried about cataract formation at the time because the uveitis was on the verge of causing vision loss.

I was devastated when cataract formed in my left eye only at first. That was after 5 more flares of uveitis in my left eye all of which were all treated with at least 60 mg of prednisone orally. I asked if prednisone caused the cataract in my left eye. My ophthalmologist said uveitis more likely caused it.

A cataract formed in my right eye and "ripened" rapidly a year after my first cataract surgery. I didn't ask what caused the cataract in my right eye. Uveitis hadn't yet happened in my right eye when the cataract formed in my right eye.
---------------------------------------------
In subsequent years I frequently used prednisolone 1% eye drops. There was never any concern about cataracts after I had cataract surgery on both eyes before the age of 40.

If you are very concerned over the weekend --- call your doctor.

If it doesn't seem to get worse and the steroid eye drops help ... * hit it with prednisone as planned and approved by doc and call on Monday --- the drops do have a soothing effect if there is inflammation in your eye.
-------------------------------------------------------------------
Since you have enteropathic problems... I wouldn't be surprised if you have a mild case of uveitis.
https://www.webmd.com/ibd-crohns-disease/crohns-disease/crohns-eye-problems

REPLY
1 reply
pb50 | @pb50 | Jun 7 5:14pm
In reply to @dadcue "I would think the ophthalmology office that did the surgery would have someone on call for..." + (show)
@dadcue

I would think the ophthalmology office that did the surgery would have someone on call for any concerns you have.

I don't think your intraocular pressure (IOP) is the problem because your symptoms are relieved with the prednisolone 1% eye drops. Steroids increase IOP but not that much.

When my eye felt like it was going to explode it was within a few hours of going home after cataract surgery. High IOP can happen but it usually happens within 24 hours following cataract surgery and transient. I no sooner got home and I was calling my ophthalmologist with severe eye pain. I had a prescription for the pressure drops but I didn't have time to get it filled. I didn't even know my IOP had reached the critical threshold. My ophthalmologist apologized and said he should have put the pressure drops in before I went home.
----------------------------------------------------------------------------------
I'm personally not afraid to use prednisolone 1% eye drops. I've used them for uveitis and other eye problems. My very first uveitis was treated initially with steroid eye drops. I had instructions to call if my uveitis symptoms worsened otherwise follow-up was going to be 2 days later. I was calling in every day with worsening symptoms. They would increase the frequency of the steroid eye drops until I was up to hourly drops or as many as possible. My ophthalmologist gave up on the steroid eye drops. He said the uveitis was "aggressive" so he was going to hit it with 60 mg of oral Prednisone. He said I could still do the steroid eye drops for comfort as often as I wished. He wasn't too worried about cataract formation at the time because the uveitis was on the verge of causing vision loss.

I was devastated when cataract formed in my left eye only at first. That was after 5 more flares of uveitis in my left eye all of which were all treated with at least 60 mg of prednisone orally. I asked if prednisone caused the cataract in my left eye. My ophthalmologist said uveitis more likely caused it.

A cataract formed in my right eye and "ripened" rapidly a year after my first cataract surgery. I didn't ask what caused the cataract in my right eye. Uveitis hadn't yet happened in my right eye when the cataract formed in my right eye.
---------------------------------------------
In subsequent years I frequently used prednisolone 1% eye drops. There was never any concern about cataracts after I had cataract surgery on both eyes before the age of 40.

If you are very concerned over the weekend --- call your doctor.

If it doesn't seem to get worse and the steroid eye drops help ... * hit it with prednisone as planned and approved by doc and call on Monday --- the drops do have a soothing effect if there is inflammation in your eye.
-------------------------------------------------------------------
Since you have enteropathic problems... I wouldn't be surprised if you have a mild case of uveitis.
https://www.webmd.com/ibd-crohns-disease/crohns-disease/crohns-eye-problems

Jump to this post

I called my Rheumy — he said what you said about 1% Prednisone. I see him soon and we will talk then.

I’m sure its on the mend. And the
possibility of uveitis occurred to me…. Because that's the brand of luck I have 🙂

You're the best. Thanks much.

REPLY
pb50 | @pb50 | Jun 8 11:23am

All is good in the kingdom today. Beautiful weather and neither eye hurts. 😁

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