Effect of Topical Periocular Steroid Use on Intraocular Pressure: A Retrospective Analysis

Abstract

Purpose: To study the effect of periocular steroid use on intraocular pressure (IOP). Methods: Charts of adult patients with atopic dermatitis or eczema treated with topical periocular steroid creams and ointments from January 1st, 2007 to October 1st, 2017 were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data were collected regarding gender, treatment regimen, as well as IOP prior to and during treatment. Steroid responders were identified. Statistical analysis was performed using linear mixed effects models adjusting for follow-up time to test the relationship between pre and posttreatment IOP change adjusting for intereye correlations. Results: Thirty-one patients were identified. Twenty-one were treated bilaterally and 10 unilaterally. Five patients were glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1–83.9 weeks. Patients were treated with fluorometholone (42%), loteprednol etabonate (23%), dexamethasone-neomycin-polymyxin B (13%), hydrocortisone 1% or 2.5% (3%), and tobramycin-dexamethasone (19%). In the combined sample, there was no significant IOP change even after adjusting for follow-up time (mean change: +0.44 mm Hg, p = 0.126). However, eyes with baseline IOP ≥ 14 mm Hg had a significant increase (+0.73 mm Hg/year, p = 0.032). Individual steroid responses included the following: 1 intermediate and 30 low responders, of which 19 patients had an IOP change of <1 mm Hg. One patient had a clinically significant intermediate steroid response of 7 mm Hg. Conclusions: Periocular steroid treatment causes a statistically significant rise in IOP in eyes with higher baseline IOP measurements, the risk of which increases with follow up. While this change is not always correlated with a clinically significant rise in IOP, clinicians should monitor more closely patients at greatest risk of steroid response.

Nomenclature and clinical phenotypes of atopic dermatitis

“…82 Of note, long-term use of potent topical steroids to treat eyelid dermatitis can cause eyelid skin atrophy due to the thin skin of the eyelid, as well as serious adverse events such as glaucoma and cataracts, which are also associated with use of systemic corticosteroids. [83][84][85] Head and neck dermatitis. In adolescents and adults, facial AD, often seen as xerotic, scaly, erythematous, and sometimes lichenified plaques affecting the face and neck and eventually the scalp, is one of the causative factors of HND (Figure 3e).…”

“…82 Of note, long-term use of potent topical steroids to treat eyelid dermatitis can cause eyelid skin atrophy due to the thin skin of the eyelid, as well as serious adverse events such as glaucoma and cataracts, which are also associated with use of systemic corticosteroids. 83–85…”

Evaluation and management of systemic corticosteroids-induced ocular hypertension in children with non-Hodgkin lymphoma

“…In addition to the well-known systemic complications of CSs, CSs-induced ocular hypertension (OHT) has frequently been reported, which can possibly lead to irreversible visual impairment (2). However, to date, most of these studies have been performed on adult patients and topical CSs use (3)(4)(5)(6).…”

Systemic toxicity to betamethasone ointment

“…After reduction of clobetasol, these active phase symptoms dissipated 3 . One report recounted that topical corticosteroids on the skin can increase intraocular pressure 6 . In a 6‐week‐old male infant, application of topical betamethasone after bilateral phacoaspiration resulted in increased intraocular pressure and body weight gain, with development of a cushingoid habitus 6‐8 weeks after initiation of topical steroids 7…”