Q: I am a 40 years old man having glaucoma. I was put on Xalatan 10 months back because of high intra-ocular pressure (IOP) of 26. My eye angle was found to be open, but the optical coherence tomograpghy (OCT), Heidelberg retina tomography (HRT), GDx nerve fibre analysis, visual fields including short-wavelength automated perimetry (SWAP) were found to be normal. Since I had taken nasal steroids off and on for the last few years, I was suspected to be steroid responder and Xalatan was stopped after 4 months. After that, my IOP ranged between 18 and 21 for the next three months. Last month I took vasoconstrictor nasal drops Otrivin and an anti histamine for 7 days. Now I am having diurnal variation in IOP between 18 and 24, within the same day. My cornea thickness is 560 micron.

• Could these drugs be the cause?
• Is it normal diurnal variation?
• Should I be again put on IOP reducing drops?
• Is there any relation between IOP and physical exercise and blood pressure?
• Is there any relation between mental stress and IOP? What should I do?

A:If you are a steroid responder, any steroid medication may increase the IOP. However, we only treat IOP of above 30 mmHg mainly to prevent glaucoma. Unless your optic disc and visual fields are affected, you don't need treatment for this much of diurnal variation. Family history of affected blood relative is also significant. Blood pressure does affect your IOP/glaucoma. Mental illness itself does not cause glaucoma but some of the treatment used for mental illness can affect glaucoma/IOP. There is no need to worry but I would advise you to see your eye specialist once a year with visual field test and eye/vision check only not all these exhausting tests you have had done, which benefits them more financially than your disease process.