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Haziness in sight,optic nerve swollen due to pressure, told for laser treatment. Effectiveness and side effects of laser ?

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Practicing since : 1977
Answered : 525 Questions
Dear Doctor,

My mother (aged 46) is having trouble with her eyesight since 4-5 days. She is having haziness (dim) in sight. One of her eyes had been diagnosed as largely blind (by birth) few years back. One ophthalmologist diagnosed that optic nerve of both the eyes has been swollen (or blocked?) due to eye pressure and referred for a laser treatment.

When she consulted another specialist she was given New I-site tablets (diatery suppliments of Carotenoids, minerals and vitamins) and Nepalact (Nepafenac Opthalmic Suspension) eye drops and asked to wait for 20 days to see whether the medicines improve the conditions before going for laser treatment. She was told that conditions could be due to stress or lack of sleep. She complains that her vision get bit cloudier when after putting eye drops. Is it normal?

She can only see a person clearly (facial details) when he is very close. She cannot read books now (she had done it just a week back with her glasses) and can only see big fonds (for example: Newspaper name). She had the problem of swellings below the eyes after being emotional (crying). She can see things more clearly when light is put on or when outdoors. She describes her constant hazy sight as something like the feeling of dim sight when coming indoors after being in bright light.

I would be grateful if you could explain this condition. Will she be able to recover from this? Will the tablets and eye drops help? Whether Laser treatment is essential and what are the side effects of it? How effective laser treatment in curing this condition? What she can do to ease her eyes (food, relaxing etc..)?

Please help in answering these questions.

Thank you

Posted Tue, 22 May 2012 in Vision and Eye Disorders
Answered by Dr. N. K. Misra 12 hours later

Thanks for posting your query.

As you have told there seems to be some optic nerve damage in the remaining eye which was the only working eye as yet. This optic nerve damage was due to rise of intra ocular pressure. Small rise of pressure is managed by laser treatment and larger, non responding pressure is managed surgically.

I assume that, this waiting period is to be utilized by medically controlling the IOP(Intra ocular pressure). Contrary to this line you are not being given IOP lowering treatment.

IOP which is normally 17 and usually allowed up to 20 is treated with Timolol maleate eye drops and if necessary with oral Acetazolamide tablets, but in your statement there is no mention of measurement of raised IOP and no treatment is being offered for the same.

The cloudiness of vision after puting in the eye drops may be due to the solution in the eye effecting the vision but that should not last more than few seconds.

Please see both the doctor's prescriptions carefully for any mention of IOP written as tension otherwise scan and mail me those papers. You have an option to upload the reports on the right hand side of your query, please utilize that to attach your reports.

If there is IOP rise then specific treatment for IOP control was to be started to control visual loss.

Complications of laser treatment are minimal.

Isite and nepalact eye drop are not IOP lowering medication. So they will not control the IOP.

Laser treatment is to control IOP for which IOP lowering treatment has not been given.

Please go through the prescriptions again and get back to me immediately.

In the meanwhile contnue with the medications.

Please write back with the reports so that I can suggest further.

Awaiting your reply.

Above answer was peer-reviewed by
Follow-up: Haziness in sight,optic nerve swollen due to pressure, told for laser treatment. Effectiveness and side effects of laser ? 15 hours later
Dear Doctor,

Thank you very much for your reply.
I will get back to you tomorrow (I have asked my brother to send me scanned images of the prescription/reports).

Thank you
Answered by Dr. N. K. Misra 1 hour later

Thank you for writing back.

I'm waiting for your details to come to a conclusion regarding your mother.

Above answer was peer-reviewed by
Follow-up: Haziness in sight,optic nerve swollen due to pressure, told for laser treatment. Effectiveness and side effects of laser ? 16 hours later
Dear Doctor,

I have just uploaded the two 'reports' which probably don't indicate much.
Since I was not there while consulting doctor, I am not sure whether it is IOP or not.

The 'first' doctor mentioned the 'pressure' and asked to come for laser treatment on 13 March. The 'second' doctor mentioned the swelling of the optic nerve and but (refuted the first doctors diagnosis) and said there is no pressure and prescribed those medications.

Could this be 'nerve' pressure (if there is such a thing) rather than IOP.
For what condition Isite and nepalact eye drop are usually prescribed?

Consulting a third doctor at TreeG Eye hospital confirmed second doctors diagnosis and asked to continue the same medication for a month.

Could the first doctor's diagnosis and asking to do YAG PI be wrong?

My mother is feeling mild pain in the eye too and also warming up of her head crest (her uterus had been removed 2 years back due to fibroids).

Please comment.....

Thank you

Answered by Dr. N. K. Misra 1 hour later

Thanks for getting back to us.
I do not see any attachment with this mail.

It is important to make the correct diagnosis:
The diagnosis of nerve swelling, which requires oral steroids and a Computerized Tomography (CT) scan of brain to rule out any intra cranial involvement.
Intra Ocular Pressure (IOP) rise, which needs a different treatment.
This differentiation is very important, as it decides your future line of action.

The treatment being offered does not take care of anything. Isite is an antioxidant; this visual loss is not due to dietary deficiency.
These eye drops are mild anti inflammatory, which will not work so XXXXXXX in the eye.

First you have to have a working diagnosis, without that it is aiming in the dark with little result.
Retinal examination will bring us to a diagnosis. Then we get results from specific treatment.

Please get a report of the retinal examination and try re-uploading all the reports again.

Or you can mail them to YYYY@YYYY quoting your query ID and say for attention of Dr. N. K. Misra.

Above answer was peer-reviewed by
Follow-up: Haziness in sight,optic nerve swollen due to pressure, told for laser treatment. Effectiveness and side effects of laser ? 4 hours later
Dear Doctor,

I have uploaded (reloaded) the report (these are just slips given to her which have no other information. Its quite strange that no other reports have been given.

Yes, its high to have a correct diagnosis. Thank you for clarifying what need to be done immediately.

I will take her to a specialist, clarify and get done a proper retinal examination (if it has not been done) and get a report of it and will get back to you.

Thank you..

Answered by Dr. N. K. Misra 8 hours later

Thanks for keeping me updated.

I have seen the attachments.

At times there are patients whose diagnosis is not very clear.

These are cases where one has to go in for investigations. I am very much against the approach of advising multivitamins for 15 days and wishing the problem to go away, that too in a single eyed patient.

I am glad that you were alert enough not to be satisfied with that.

Please get her checked and keep me informed.

Please write back if you have additional concerns.

Above answer was peer-reviewed by
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