. Glaucoma and cataract as complications to topical steroid therapy. Acta Ophthalmol (Copenh). 1966;44(3):307-12. doi: 10.1111/j.1755-3768.1966.tb08035.x.
[PMID: 5953285] [DOI: 10.1111/j.1755-3768.1966.tb08035.x]
Related article: Eye diseases
Related article: Eye diseases
A variety of palliative medications and over the counter supplements are available to patients suffering from glaucoma, uveitis, cataracts, and eye inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue.. Perhaps the most important thing MP patients with eye symptoms can do is to protect the protect their eyes from the effects of light both indoors and outdoors while they exhibit the symptoms of photosensitivityAbnormal sensitivity to sunlight and bright lights. Also referred to as "sun flare" or "light flare.".
Because they suppress the innate immune responseThe body's first line of defense against intracellular and other pathogens. According to the Marshall Pathogenesis the innate immune system becomes disabled as patients develop chronic disease. and contribute to disease relapse, MP patients should avoid immunosuppressive drugs such as eye drops with Prednisone except during emergencies. Opt instead for eye drops and medications which do not contain steroids such as Optive or artificial tears instead.
Patients who need temporary relief of their eye symptoms should contact their opthalmologist, physician or pharmacist for advice about palliative medications. Patients' opthalmologists who believe they need immunosuppressant eye drops to temorarily control inflammation may do so while on the Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. (MP).
Patients who are taking steroids should work with their physician to wean from the medication.
Related section: Marshall Protocol for chronic eye diseases
Normally the conjunctiva is clear white. Visibly red veins of the eye is a sign of vasculitis (inflammation of the veins) and is very common in patient with chronic inflammatory diseases. Because it is in the eye, it is very obvious and disconcerting. But it is also common in the skin, small varicose veins, easy bruising; in the gut, microscopic blood loss and in hidden areas.
Because immunopathology is a result of cytokine release and apoptosis (cell death) of infected cells caused by innate immune activation, this does occur as the bacteria as part of their life cycle will manifest in more typical forms causing immune identification and response. However, this is only a tiny fraction of the total bacterial load and unsupported, the immune system will not be able to eradicate the infection.
Various symptoms have been reported, including increased sensitivity to light, bloodshot (red) eyes, conjunctival bleeding, glazed vision, infection type symptoms and various visual disturbances. Vision exams may not reveal any abnormality.
Visual changes may also originate in the brain without organic change in the eyes. Eye muscles can also become weak as they heal. These eye symptoms could also be exacerbated by immunopathology.
Further, what may often feel like an allergic reaction in the eye is, in most cases, actually due to changes in immunopathology, meaning that no additional treatment is required.
Increased allergic-like reactions during the MP are fairly common and represent increased innate immune response.
Greg Blaney, M.D.
The first recourse for improving symptomatic eyes is to limit the amount of light one's eyes are getting. This may mean:
The MP is designed so that patients can minimize the chance of eye damage due to increased inflammation by maintaining a tight olmesartanMedication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. Also known by the trade name Benicar. blockade. Altering the dose and scheduling of antibiotics will manage the severity of the immunopathology by slowing the rate at which bacteria are destroyed and thus reduce the chance of eye inflammation. In addition, a variety of eye medications and drops are available to treat eye inflammation and dry eye.
Some patients have reported that their dry eye responds better to artificial tears which do not contain preservatives or special ingredients for “red eye,” allergies, etc.
See artificial tears
Patients should work with their doctor or ophthalmologist to limit their use of substances which affect the proper functioning of the immune system. Patients' doctors who believe they need immunosuppressant eye drops to temorarily control inflammation may use the drugs while on the MP.
Be advised that use of steroids delays resolution of original disease symptoms while on the MP, and can have serious side effects. These side effects include glaucoma,1) cataracts,2) ocular hypertension,3) various other side effects, 4) as well as increase in ocular pressure.
Although newer corticosteroidsA first-line treatment for a number of diseases. Corticosteroids work by slowing the innate immune response. This provides some patients with temporary symptom palliation but exacerbates the disease over the long-term by allowing chronic pathogens to proliferate. with lesser pressure elevating characteristics have been developed, corticosteroid-induced ocular hypertension and glaucoma continue to be significant risks of local and systemic administration.
McGhee et al.5)
When possible, physicians should try weaning their patients from immunosuppressive eye drops. Try going down one drop a day, and then dropping down one drop every other day. Patients are more likely to be successful weaning from prednisone when they wean very slowly.
Also, note that changing from Pred Forte eye drops to one of the lower strength prednisolone eye drops (such as Pred Mild, or Lotemax)
Regular use of olmesartan as per the MP guidelines can help a patient wean from higher doses of prednisolone (Prednisone).
Tumor necrosis factor-alphaA cytokine critical for effective immune surveillance and is required for proper proliferation and function of immune cells. or TNF-alphaA cytokine critical for effective immune surveillance and is required for proper proliferation and function of immune cells. is a cytokineAny of various protein molecules secreted by cells of the immune system that serve to regulate the immune system. critical for effective immune surveillance.6) TNF-alpha inhibitors, also known as TNF blockers, anti-TNF drugsDrugs which interfere with the body's production of TNF-alpha - a cytokine necessary for recovery from infection or TNF-alpha antagonists, are drugs which interfere with the body's production of TNF-alpha.7) Anti-TNF drugs are expensive, ineffective at treating chronic disease and have a number of adverse effects such as increase risk of serious infection such as mycobacterial infection.8) 9)
Moxifloxacin ophthalmic solution is used to treat bacterial conjunctivitis (pink eye; infection of the membrane that covers the outside of the eyeballs and the inside of the eyelids). Moxifloxacin is in a class of antibiotics called fluoroquinolones. A report from a patient on the MP indicated it was effective for resolving their acute eye infection symptoms.
Pfizer markets Terramycin opthalmic ointment for humans in other parts of the world, and as a veterinary medication in the US, therefore it may require some research to identify a source for it. Calling around to local veterinary supply stores or looking online may be options. It is described as a “versatile antibiotic ointment with broad-spectrum antibacterial activity against gram-positive and gram-negative organisms.”
Some people on the MP who have anterior uveitis have reported it to be very helpful. It should penetrate the front part of the eye, just as the various eye drops used to treat uveitis do.
A good and natural remedy for eye symptoms is the use of chamomile tea eye compresses. Can either use cool tea on cloth or the actual tea bag on the affected eyes for five to ten minutes, two to three times per day. You may find that warm or cool or wet compresses may help to relieve uncomfortable eye symptoms.
A punctal plug is a small medical device that is inserted into the tear duct (puncta) of an eye to block the duct. Patients should always make sure their hands are clean when touching their eyes.
Inflammation can damage the delicate structures of the eyes. Anyone with a history of eye inflammation, especially uveitis or iritis, should have their eyes examined by an ophthalmologist regularly while on the Marshall Protocol. For example, people with sarcoidosis are advised to see an ophthalmologist every six months. Over time, the MP should address such inflammation, but one could have occasional increases of inflammation that could require some temporary medical intervention.
Related section: Patients experiences (eye diseases)
My tear ducts are producing their own/adequate tears now on the MP for 3 mos. About 10 yrs ago I was told that they weren't producing enough tears and have gradually been using more and more artificial tears - especially upon awakening in the a.m.'s. When I would wake up my eyes would feel so dry it was scary and my eyes would literally BURN when I put the drops in!!! WOW!
Elisabeth, MarshallProtocol.com
I just wanted to let you and others know about my solution for painful dry eyes, especially while sleeping or first thing in the morning for me. I bought a case of these small reusable bottles from a pharmacy that deals with a lot of specialty stuff near here, filled with pure sterile saline (water at the same salinity as our bodies) which is normally used to flush out IV lines before they start IVs. I put a needle that screws into a syringe into the rubber top, and whenever my eyes are bothering me, i just unscrew the Luer lock syringe (you leave the needle part stuck in the bottle permanently) and drop some saline into my eyes. i look right to left a few times and this distributes it well. Instant Heaven.
I do this because i react to EVERY product out there for eyes. And it took me a long time to get this figured out. I tried putting this saline into a dropper bottle and using that but i eventually ended up having something akin to an infection, probably because the dropper was getting dirty and going back into the source bottle. The way I have done if for months now there is really no way for germs to get into the source bottle.
Satay, MarshallProtocol.com
For dry eyes I use Bion Tears. They don't have preservatives which can cause trouble in some people. My eye man prescribes three boxes at a time with a special authority and I get them at the PBS basic cost for the three. I find they work very well.
Eliz, MarshallProtocol.com
I react to every product out there, so it took me a long time to figure out a solution for my painful dry eyes. I use small reusable bottles filled with pure sterile saline – water at the same salinity as our bodies – which is normally used to flush out IV lines before they are used. I bought a case of the bottles at a pharmacy that deals with a lot of specialty stuff.
I put a needle that screws into a syringe into the rubber top, and whenever my eyes are bothering me, I just unscrew the Luer lock syringe (you leave the needle part stuck in the bottle permanently) and drop some saline into your eyes. I look right to left a few times and this distributes it well. Instant heaven.
Satay, MarshallProtocol.com
My left eye is my worst as far as being dry. Sometimes nothing will focus. Finally, it will dawn on me, and I use artificial tears and my vision clears up!
What really lets me know that it's dry is that I can often put four drops of artificial tears in my left eye and none of it runs out of my eye. At the same time, I put two in my right eye, and it runs down my cheek. That can happen whether or not the left eye has been tearing.
Lottie, MarshallProtocol.com
I use Allergan-Refresh-Lubricant-Ointment-Nighttime |Refresh PM gel by Allergan, sourced through Amazon, a night-time product for soothing dry eyes. It is actually an ointment developed for dry eyes that bathes the eyes all night. It lasts much longer than the gel drops. Refresh PM causes blurry vision which is why it was developed for night time use. Works great!
DNStog, MarshallProtocol.com
I found the artifical tears were not working well enough for me, had to use them at least once an hour. I got some lubricating drops, Walmart's Equate Gentle Lubricant Eye Drops, and they're working much better.
Jillian, MarshallProtocol.com
It is not unusual for Sarcoidosis patients to have “dry eye”. Which sounds strange when a person is told that by their ophthalmologist, because “dry eyes” tend to water a lot, with tears running down their face. When I said, “How can they be dry when they're watering all the time!!??” My doctor kept trying to explain to me that it's not the same tears, that the tears that run down your face, are the ones that also appear when you cry or when your eye is irritated, and they don't lubricate the eyes.
Finally, it dawned on me, and I asked him, “So, there are two different tear ducts?” He nodded, “yes”, and told me that the problem is that the tears that are necessary to maintain the moisture in the eyes are the ones that are missing or reduced by the inflammation of Sarcoidosis. And, so lots of the “crying” tears are manufactured in an attempt to maintain moisture in the eye. Since they aren't very good at it… it takes a lot, and they run down your face.
The reason that I mention “dry eye”, is that it can also affect your vision. My left eye is my worst as far as being dry… or “watering”. And, sometimes, my eye doesn't water much, if at all, and yet my vision is bad. Nothing will focus. Finally, it will dawn on me, and I use artificial tears… and my vision clears up!!
What really lets me know that it's dry is that I can often put FOUR drops of artificial tears in my left eye and none of it runs out of my eye. At the same time, I put two in my right eye… and it runs down my cheek. And, that can happen whether or not the left eye has been “tearing”. And, you only want to use plain artificial tears for “dry eye”. Not any of the ones that have ingredients for “red eye”, allergies, and such.“ People also report preferring preservative-free articial tears to the ones with preservatives.
Lottie, MarshallProtocol.com
My tear ducts are producing their own/adequate tears now that I have been on the MP for 3 months. About 10 years ago I was told that they weren't producing enough tears and have gradually been using more and more artificial tears - especially upon awakening in the AM. When I would wake up my eyes would feel so dry it was scary and my eyes would literally burn when I put the drops in!
Elisabeth, MarshallProtocol.com
You may have experienced an ophthalmic migraine, which i have all the time. They are perfectly harmless, although they can be scary the first few times you have them… ha!
Sunflower
Without an eye mask my eyes were always tired from a night of ever-present LCD clock displays, charging mobile phones, other electrical appliances, and light that creeps in from cracks in the windows and under doors. I was surprised at the difference that little eyemask change made.
JRFoutin, MarshallProtocol.com
The following suggestions may help relieve burning or tearing:
JRFoutin, MarshallProtocol.com
I just saw that you are in need of ABX for eye? If so, I recently had pink eye, and another member suggested VIGAMOX. This is moxifloxacin hydorchloride ophthalmic solution 0.5% comes in 3ml bottle.
You know how I am very medication sensitive, but I did just fine with this.
Lori (LH1953), MarshallProtocol.com
I may be experiencing a detached retina, but it could be something else. I got the symptoms a few times yesterday, but it disappeared. Now, the symptoms are back. When I look dead ahead, there appears to be a black slash where my vision should be in the upper regions of my vision in my left eye; if I look up, it disappears. I've had these symptoms previously (over 20 years ago they happened on/off for a weekk or so) and they disappeared on their own without my ever seeking medical help.
Had my intensely light intrusive eye appointment this AM and was told that it was a “subjective visual disturbance,” as there is no explanation for what I was experiencing. No physical evidence, no readily available “sounds like.” I was told that if I lose part of my vision for a full day, to call the eye doctor the next day for an immediate appointment. This, of course, is why I didn't see an eye doctor 20 years ago when this happened for a couple of weeks straight: weird symptoms, no explanations.
eClaire
MP day 142 (17/05/06) I am not sure where this fits into things but it is now gone and my eyes are evenly open. I think this is a significant improvement.
VickiSA
My daughter has been on the Methotrexate and the Predforte eye drops. (You can read more about her at Teen on MP.)
My understanding is that people generally wean from Methotrexate so they can tell at what dose their symptoms return. Otherwise, I don't think that weaning is necessary.
My daughter has had a lot of benefit from the Marshall Protocol while using Pred Forte eye drops - but we are concerned that the Pred drops might be interfering with resolution of her uveitis. From my experience with my daughter, I imagine that you could benefit from the MP, even while using your current low dose of Pred Forte eye drops. If you can successfully wean from the pred drops, that would be even better.
Benicar is likely to help you wean down from the pred drops (just as it helps people to wean from oral prednisone). (There is also research that suggests that medicine in the same class as Benicar helps.
Margo