Effect of Systemically Administered Corticosteroids on Intraocular Pressure and Fluid Dynamics

Abstract

Topically used corticosteroids have been implicated as a causative factor in the elevation of intraocular pressure. The relationship between systemical corticosteroid medication and rise of intraocular pressure is not yet, however, clearly documented. While some authors observed a hypertensive effect as a consequence of treatment with systemically-administered corticosteroids (McLean Weekers, Grieten, Watillon and Prijot I964), others (Tillet 1952; Lee 1958) did not observe this relationship in their examinations of patients suffering from general diseases (severe asthma, rheumatoid arthritis and so on) treated with longterm systemic steroid therapy. Most authors are of the opinion that the increase of the ocular tension, after prolonged topical treatment with corticosteroids is due to a decrease in outflow facility. LinnCr (1959) observed an increase of aqueous flow in normal subjects on topical prednisone treatment over a period of one week with the "suction cup" and Nicholas (1964) showed, with tonography, a decrease from 0.28 to 0.22 pl/min. per millimeter of Hg in outflow facility as well as a statistically significant increase of aqueous flow from 0.76 to 2.05 pllmin. in ten normal subjects.In the following investigation, the effect of corticosteroids administered systemically for a short time on the ocular fluid dynamics in normal human eyes has been studied. M A T E R I A L A N D METHODSTwo groups of subjects were studied:A) Ten patients (male and female) without ocular or systemic diseases, aged ") Received February 2nd 1965.Auricchio, G . and Diotallevi, M.: Can the recovery rate of the intraocular volume be used for measurements of the aqueous inflow? Researches on normal human and rabbit eyes. Acta Ophthal. (in press). H . N., Mills, D. W . and Becker, B.: Steroid-induced elevation of intraocular pressure. Arch. Ophthal. Chicago 70: 15-18 (1963). Bernstein,

Effect of Orally Administered Hydrocortisone on the Rate of Aqueous Flow in Man

“…Increased aqueous formation after systemic administration of corticosteroids measured by tonography or suction cup method has been reported by several investigators (Lindholm et al 1965;Godel et al 1972;Diotallevi & Bocci 1965). All these studies were performed to investigate the effects not of a dose of systemic steroids but of chronic use of systemic steroids.…”

Steroid-Induced Iatrogenic Glaucoma

“…This has been confirmed by comparing steroid-treated patients to the normal population with no steroid treatment or to a group of patients with a similar disease but without steroid treatment [27,87] . With systemic steroids, there was evidence for both an increase in flow, especially upon short-term administration, and a decrease in the facility of outflow [77,88] . In patients who are steroid responders, pressure elevations with systemic steroid use average approximately 60% of those produced by topically applied steroids [89] .…”

“…The IOP usually returns to normal within 2-4 weeks after discontinuing the steroid [131] . In cases with repository-steroid injection and high IOP, the residual subconjuctival or intraocular steroid may be removed [28,[86][87][88] . In the two cases with very high IOP described by Agrawal et al [132] , the removal of the intravitreal corticosteroid by vitrectomy reversed the elevated IOP.…”

Adrenocortical Hormones and Glaucoma

“…I n patients under long-term systemic treatment with corticosteroids the intraocular pressure was found to be elevated without change in facility of outflow indicating an increase in the rate of aqueous flow ( 11,19). Following systemif: administration of corticosteroids during as short a period as 3 days the aqueous flow was increased ( 13). A patient with disseminated lupus erythematosus was given systemic corticosteroid treatment during one year.…”