Corticosteroid-induced glaucoma: a review of the literature

Abstract

The intraocular pressure rise that can complicate the use of topical or systemic corticosteroid has been recognised for 50 years. More recently, following isolation of the myocilin gene (previously known as the trabecular meshwork inducible glucocorticoid response or TIGR gene), there has been renewed interest in this steroid-responsive phenomenon. Furthermore, the currently fashionable use of injectable intraocular steroids in the management of clinically significant subretinal fluid and macular oedema has resulted in an increased incidence. Animal studies, cell biology, molecular biology, and an improved knowledge of genetics have provided a better understanding of the mechanisms behind the response. The purpose of this review is to describe the risk factors for developing corticosteroid-induced glaucoma, to discuss the underlying mechanisms and genetics of the condition and to present management options.

Efficacy and Safety of Sustained Release Dexamethasone for the Treatment of Ocular Pain and Inflammation after Cataract Surgery: Results from Two Phase 3 Studies

“…The incidence of steroid-induced glaucoma appears to be related to dose and duration of application of the medication [31].…”

Irreversible visual loss secondary to excessive topical steroid use in eczema

“…3 Adverse effects of facial steroids on the eye have been reported. 4 Risk factors 5 for developing IOP rise include: pre-existing history or family history of POAG, type 1 diabetes, connective tissue disorder such as rheumatoid arthritis, or high myopia. The elevation in IOP typically occurs within a few weeks of starting steroids and normalises a few weeks after cessation, although IOP may sometimes remain elevated, depending on potency and routes of steroid administration.…”

Traumatic glaucoma with features of unilateral pigment dispersion

“…In our case, we believe that the blunt ocular trauma sustained was insufficient to cause angle recession but culminated in a greater peripheral increase in anterior chamber depth, iridial concavity, and ultimately the irido-zonular contact necessary for pigment dispersion. [23][24] In our patient, IOP elevation occurred 1 month following initial presentation and steroid use. Steroid-induced glaucoma typically occurs within weeks of initiation of topical steroid therapy, with pressures as high as 60 mm Hg reported following prolonged use.…”

“…Steroid-induced glaucoma typically occurs within weeks of initiation of topical steroid therapy, with pressures as high as 60 mm Hg reported following prolonged use. [23][24] …”