Steroid-Induced Glaucoma: Avoidable Blindness

The use of steroids (eye drops, and systemic administration such as oral medication) can sometimes cause glaucoma.

Considering the current state of the disease, the doctor adjusts the dose and duration of steroids.

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Steroid-Induced Glaucoma

It is important to think carefully about how to use steroids to control inflammation in the eye.

I treat patients while thinking about the current state of inflammation from the standpoint of immunology:
Conjunctivitis, allergic conjunctivitis, dry eye, keratitis, uveitis, diabetic retinopathy (macular edema), retinal vein occlusion (macular edema), chalazia and styes (hordeola), and others
In all of these, steroids need to be used appropriately.

The steroid eye drops we usually use have almost no side effects.
But continuing the drops can cause the main side effect: a rise in eye pressure.

For diseases with strong inflammation, a somewhat stronger steroid is used.
In addition to monitoring eye pressure, careful adjustment of the duration and frequency of use is important.

Eye drops:
Flumetholon® / Odomel® / fluorometholone (generic products) / Pitos®
Rinderon® / Santhezone® / Orgadrone® / Chondron Dexa® / Visualin® / D·E·X® / DM-Zolone® / Teikazon® / PS-Zolone®
Eye ointments:
Rinderon-A® / Santhezone® / Predonine® / Neo-Medrol® / D·E·X® / prednisolone acetate

If the problem is noticed early and handled appropriately (that is, the drug is stopped), a rise in eye pressure rarely leads to visual impairment.

Even when eye pressure rises, there are no symptoms.
There are cases in which a person with atopic dermatitis or eczema who had applied steroid ointment near the eyelids for a long time noticed that their vision was strange and, on seeing an eye doctor, was found to be at risk of blindness¹.

Steroid-induced glaucoma: “avoidable blindness”²
People who are using ointment prescribed by a dermatologist, or oral or inhaled steroids from an internist, also need to watch their eye pressure.

* The essence of how steroids raise eye pressure is a change in the mesh-like structure of the trabecular meshwork, the drainage path for fluid in the eye.

(References)
1. Aggarwal, R.K., Potamitis, T., Chong, N.H.V., Guarro, M., Shah, P., Kheterpal, S., 1993. Extensive visual loss with topical facial steroids. Eye 7, 664–666. https://doi.org/10.1038/eye.1993.152
2. Phulke, S., Kaushik, S., Kaur, S., Pandav, S., 2017. Steroid-induced Glaucoma: An Avoidable Irreversible Blindness. J Curr Glaucoma Pract 11, 67–72. https://doi.org/10.5005/jp-journals-10028-1226

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