Case Report: Steroid-induced Ocular Hypertension in a 6-year-old Boy

Abstract

SIGNIFICANCE: Systemic corticosteroid use in children is rare because of known risks of adverse effects. The increased prevalence of multisystem inflammatory syndrome associated with COVID-19 may change this. It is critical for eye care providers to be aware of potential severe and rapid ocular hypertensive response to prevent irreversible vision loss. PURPOSE:The purpose of this study was to report the importance of early monitoring of intraocular eye pressure in pediatric patients on systemic steroid medication.CASE REPORT: A 6-year-old White boy presented with a complaint of headache for 2 weeks. He was on his 19th day of treatment for acute lymphoblastic leukemia with oral dexamethasone and chemotherapy. IOP at presentation was 65 mmHg in both eyes measured with iCare tonometry. Treatment with maximum topical glaucoma therapy reduced IOP to normal levels and eliminated the symptom of headache.CONCLUSIONS: This case reminds eye care providers to be aware of the potential ocular hypertensive response to systemic steroid treatment and the importance of establishing early monitoring. With the emergence of multisystem inflammatory syndrome in children during the current COVID-19 pandemic, eye care providers may encounter more pediatric patients on systemic corticosteroid treatment than previously and should adjust their examinations appropriately.

COVID-19: Update on Its Ocular Involvements, and Complications From Its Treatments and Vaccinations

“…Steroid is well known to produce ocular hypertension, which may necessitate glaucoma therapy to reduce the intraocular pressure (IOP) to eliminate the symptoms associated with the acute surge in IOP and prevent potential visual field loss. 83 The administration of steroids for treatment of COVID-19 was also reported to result in central serous chorioretinopathy. 84 In a series of 7 COVID-19 cases complicated by endogenous endophthalmitis, 6 cases were secondary to mucormycosis-associated sinusitis or systemic fungal infections, and all had received intravenous corticosteroid for COVID-19.…”

“…At the time of review, there have been no reports on adverse ocular effects of remdisivir and anti–SARS-CoV-2 monoclonal antibodies in the literature. Steroid is well known to produce ocular hypertension, which may necessitate glaucoma therapy to reduce the intraocular pressure (IOP) to eliminate the symptoms associated with the acute surge in IOP and prevent potential visual field loss 83 . The administration of steroids for treatment of COVID-19 was also reported to result in central serous chorioretinopathy 84 .…”

Association Between the Use of Systemic Steroids and Ocular Hypertension as a Side Effect in Pediatric Population: A Systematic Review

“…Takasi's study reported headaches as a raised IOP symptom [29]. Another study by Prasad et al mentioned blurring of vision, eye pain, redness, lacrimation, and colored halos [31].…”

“…Out of nine, two are retrospective cohort studies [30,33], five are prospective cohort studies [31,32,34,35,36], and one is both a retrospective and prospective cohort study [37]. Three studies out of 12 are case reports [27,28,29], and one is cross-sectional [26]. All studies involved pediatric populations being treated via the systemic route of steroid administration for prolonged periods for various medical conditions.…”

“…It was thought that young age in ALL patients might be associated with the immature structure of the trabecular meshwork. Some of the studies under review concluded that younger age is an important risk factor [29,30,34]. Sugiyama et al also pointed out that younger patients with ALL aged <nine years treated with oral dexamethasone had higher IOP than those with >10 years who were similarly treated [30].…”