IOP pressure after dialation

 For the last few months, I was keeping my pressure down around 17/18 without using my xalatan. However I went to the doctor the other day and he dialated my eyes ( I hate dialation) and my eyes were feeling a little funny so I went and checked the pressure today and it was 22/23 so I used xalatan tonight.  Has anyone else experience  increased IOP pressure after dialation?

Some people do experience an intraocular pressure increase after dilation, but I think this is a discussion you should have with your doctor because several factors can be involved.

In patients with narrow anterior chamber angles, pupil dilatation can even lead to a closed angle glaucoma attack. (Have you had your angles checked?)

In my personal experience, a change of 5 mmHg can happen simply from the mental/emotional state of something I dislike. You said "I hate dialation." That alone would be enough for a 5 mmHg change in my case. The only way you could know for yourself would be to measure it with a tonometer, which is why I recommend self-tonometry (with your doctor's approval).

You may find it interesting that the glaucoma medication philocarpine works by constricting the pupils.

 For the last few months, I was keeping my pressure down around 17/18 without using my xalatan

How are you doing that Billy? 

 Elizabeth,
I had stopped taking xalatin back in Feb and my pressure has been 17/18 each week  I checked it , I have not been doing anything other than taking vitamins and my vision has been improving. but after going to the doctor last week and getting my eyes dilated my pressure is up and vision is not as sharp today as I used xalatan last night.  I am hoping it will go back to what I have been experiencing.  Dave, I wish I could afford a tonometer to do my own testing, I have been going by walmart to get tested.

billym:

I have been going by walmart to get tested.

I commend you for this. I think it is highly useful and I wish more people would do this. You should be able to get a "volume discount" for the IOP tests. I had a few different doctors of optometry that worked with me initially and they all gave me really good pricing for the intraocular pressure checks.

Next time you go, find out what brand and model tonometer they are using. Find out if they have more than one type of tonometer, and if they do, note which model is used for each of your IOP exams.

Also, if your intraocular pressure is checked with the "air puff" tonometer, it is typical that the technician will perform one measurement in each eye. This is not enough. You need to repeat the measurement in each eye at least 3 times.

For your records, note all three measurements in each eye on each visit.

With cooperative doctors, I and others have done quite a few interesting things. Several of us have had eye pressure checked by the doctor, then gone out to do some exercise (various types and times ranging from 10 minutes to 30 minutes) and returned immediately for another IOP exam.

In my experience, the more frequently you can measure your eye pressure, the more insights you will gain.

Dave,

 Thanks for your comments.  I did not know to do it 3 times for the best measurement. I will talk to my local walmart about it.

 Dave,

I went by Sams Club today and asked them to check my IOP.  I have used xalatan the last few days but my pressure was 31/30 and checked again and was 29/28.  It's strange its been normal for the past 4 months and now its high.

billym:

I went by Sams Club today and asked them to check my IOP.  I have used xalatan the last few days but my pressure was 31/30 and checked again and was 29/28.  It's strange its been normal for the past 4 months and now its high.

EDIT: see my next message below instead of this one. When there is a possibility of a new medical condition or an emergency (such as angle closure), it is really not appropriate to discuss self-treatment with anything, including diet, vitamins, self-tonometry, etc.

Original message: probably not the best advise for this potential situation.

Billy - a few years ago I experienced something similar. I was unpleasantly surprised by increased intraocular pressure on a doctor's visit. That is really what started me on the path of intraocular pressure research based on frequent self-tonometer.

I can give you a few general suggestions. My intraocular pressure can change by that magnitude in response to stress. Time of day is also an important factor, as is exercise. But the things going on in my mind and my emotions are the things most directly related to big changes in my IOP like what you describe. If you want my suggestions, I can only offer you the things that have worked for me:

1. A deep understanding of the "pathological" ego. Eckhart Tolle is an excellent place to start your understanding of the ego. (See the FitEyes book club list for details.)
   
2. A deep acceptance of everything life brings me. Byron Katie is an excellent place to start for this work.
3. Powerful tools that give me mastery over my thoughts and emotions. The only approach I have found that meets my needs is Serene Impulse. If you aren't able to learn Serene Impulse now, look into mindfulness, HeartMath and other approaches until such time that you can learn Serene Impulse.
4. A very healthy lifestyle, including exercise, nutrition, etc.
   

However, I think you are saying that you would like to understand what is causing the sudden change in your IOP. Obviously, you need to be in close communication with your specialist. Your doctor needs to rule out things like angle closure.

If you want to gain extraordinary insights into what is happening -- insights that are at the cutting edge of ophthalmology's understanding of intraocular pressure -- I do not know of any option other than frequent self-tonometry. As you see, even weekly IOP checks fall short of giving you the useful data that has formed the basis of my approach. I do commend you for doing these weekly checks and you have already learned something very important. So what you have done so far is very good. But I think the comment you posted indicates that you want to understand your intraocular pressure at a much deeper level.

First, you always need to work closely with your doctor, and you need your doctor's support to do self-tonometry research. But in my experience, it is possible to gain additional insights beyond those offered by standard medical care at this time.

For many people, the additional insights gained by self-tonometry are critical. This can be true if one has problems with the medications as well as for many other reasons. In my opinion. maintaining my vision was and is worth all the time and money I am investing in self-tonometry. Tonometers are expensive, but there is no choice other than to use a reliable high-quality scientific instrument if you want to do what I am doing.

Very frequent intraocular pressure monitoring along with solid, scientific observation of all the variables has revolutionized my life after my glaucoma diagnosis. This approach can be a lot of work -- and it requires an expensive tonometer. A tonometer that supports self-tonometry is the way to go because it is very impractical to monitor intraocular pressure frequently if you cannot do it quickly, without delay and without relying on others who are not always available. To do self-tonometry research well requires the mindset of a scientist.

For me it wasn't an easy decision to purchase a tonometer, but in the end I realized that my vision is worth far more than the cost of a tonometer. Now I realize that purchasing a tonometer was one of the best decisions I've ever made.

I hope all that helps. Come visit me if you want some personal coaching.

Billy - after I wrote my prior message, I realized I should probably delete it because discussion of stress, diet and self-tonometry is appropriate only in certain contexts. Before you consider doing anything -- even working with your diet or vitamins -- you need to see a glaucoma specialist. With intraocular pressure around 30, don't waste any time trying things on your own. You need to rule out angle closure or any other situations that might be time critical.

Again, I think you have been very, very smart to have the weekly eye pressure checks. This has allowed you to become aware of a problem quickly. If you were not having frequent checks, many months could have passed before your elevated intraocular pressure was identified. Significant optic nerve damage can happen during that time. So you are in a good position to take early action because of your diligence in having frequent eye pressure checks. So good work - but follow through by taking advantage of your "early warning."

The next step is to see a glaucoma specialist quickly. I cannot offer you any advise, but it does sound alarming that your IOP went from the teens without any medication to near 30 mmHg with Xalatan, all in a very short span of time. Be smart and get your eyes checked thoroughly. Gonioscopy or UBM might be appropriate (again, I can't advise, but the link on gonioscopy might be interesting none-the-less).

Dave,

I appreciate your reply. My doctor is supposed to be a Glaucoma specialist.  My pressure has not been high until my last appointment where they dialated my eyes last Thursday.  I have been having normal pressure without using xalatan but I have been using xalatan since my appointment.  I think the dialation has something to do with my pressure now and I will have it checked again today.  Thanks for your suggestions....

 Dave,
They just remodeled my Walmart, I went in today and today was the first day it opened, I asked if they could check my pressure and they did with brand new equipment. She checked it first and it was 13/14  and the second test was 13/13.  So I guess the xalatan is doing its job but subtracting 5 for thickness of eye makes it 8.

Thanks for sharing the update. That's interesting info.

Don't forget what I said about the fallacy of subtracting 5. You can't rely on that rule. My guess is that your true IOP was probably closer to 13.

I'm not sure if these results rules out angle closure, but it sure sounds like your intraocular pressure fluctuations are more similar to what many of us with primary open angle glaucoma are experiencing. Do you still plan to see a glaucoma specialist?

 Dave,
I went by my doctor's office yesterday and requested all my tests from the last 6 years, my doctor was not there and they will give them to me next week when he returns from a trip.  He is supposed to be a Glaucoma Specialist.  I believe most doctor's give out minimal information unless you request more. I take visual fields each year and I told the nurse I wanted to compare all my previous results with my recent tests.  It's nice to hear the doctor tell you everything looks good but I want specifics. The best doctor in the world does not make you an informed patient unless you request all your info.  I am learning a lot from this site.  I still have no clue why my pressure was so high one day and normal yesterday morning, unless the tanommeter at Sams was out of calibration, the nurse did acknoledge to me that some eyes take a few days to return to normal pressure after dilation depending on what the doctor used to dilate them with.  The best thing we all can do is become informed including what drops they use for dilation, etc. Thanks for a great site.