Cushing syndrome after bilateral lensectomy

Abstract

Iatrogenic Cushing syndrome induced by oral and parenteral corticosteroid administration is a well-known complication, and necessary precautions have to be taken. Cushing syndrome, however, following treatment with glucocorticoid-containing eye drops is a very rare complication. To the best of our knowledge, there have been only four reported cases in the literature. Herein, we present an infant boy who developed Cushing syndrome after receiving dexamethasone-containing eye drops after bilateral cataract extraction to prevent postoperative inflammatory complications. At the age of 5 months, after approx. 3 months of dexamethasone therapy, the patient presented with cushingoid facies, nephrocalcinosis and failure to grow. Iatrogenic Cushing syndrome was diagnosed and dexamethasone-containing eye drops were reduced and eventually stopped. Follow-up examinations revealed catch-up growth. KeywordsIatrogenic Cushing syndrome; lensectomy; glucocorticoid-containing eye drops; nephrocalcinosis List of Abbreviations ACTH Adrenocorticotropic hormone What is known -What is knewWe present an illustrative and didactic case of Cushing syndrome in an infant due to dexamethasone-containing eye drops. So far, only four cases have been reported in children in 3 49 50 the literature (age range: 11 months to 18 years). The aim of the presented case report is to alert paediatricians to this rare complication of ocular administered glucocorticoids.

Systemic side effects of eye drops: a pharmacokinetic perspective

“…In one study, the prolonged use of 0.1% fluorometholone was beneficial for the prevention of rejection after penetrating keratoplasty and no adverse systemic side effects were reported 34. Even endocrinological side effects from eye drops containing dexamethasone have also been described in clinical trials, albeit rarely and certainly are negligible 35,36…”

Cushing's syndrome caused by use of synthetic ocular steroid

“…To the best of our knowledge, fewer than 10 cases of CS developing following ocular steroid application have previously been reported . The clinical and hormonal profiles of these cases are summarized in Table .…”

“…14 To the best of our knowledge, fewer than 10 cases of CS developing following ocular steroid application have previously been reported. [2][3][4][5][6][7][8][9][10] The clinical and hormonal profiles of these cases are summarized in Fluorometholone has been administered in a range of indications. One study reported that allergic conjunctivitis was the second most common indication of fluorometholone use in children.…”

“…CS due to topical ocular steroids is very rare. All reported cases of iatrogenic CS were caused by the use of relatively potent steroids, including prednisolone, dexamethasone and betamethasone . Fluorometholone is a modified corticosteroid regarded as having fewer side effects than other steroids.…”

“…All reported cases of iatrogenic CS were caused by the use of relatively potent steroids, including prednisolone, dexamethasone and betamethasone. [2][3][4][5][6][7][8][9][10] Fluorometholone is a modified corticosteroid regarded as having fewer side effects than other steroids. It is therefore used relatively more extensively than other potent steroids in several different indications in paediatric ophthalmology.…”