Steroid Induced Glaucoma

Definition

Steroid-induced glaucoma is a form of secondary open angle glaucoma that results from the use of steroids.

Epidemiology 5 to 6 % of the healthy subjects will

develop marked elevation of IOP, 4 to 6 weeks after administration of topical dexamethasone or betamethasone eye drops.

directly related to the frequency and duration of usage.

The risk factors include preexisting primary open-angle glaucoma, a family history of glaucoma, high myopia, diabetes mellitus and young age.

Epidemiology( continue… ) Greater Risk with Strong steroids

(dexamethasone, prednisolone… ) Lesser risk with weak steroids

(Rimexolone, hydrocortisone … ) Greater risk with ocular route ( topical,

periorbital and intraocular ) Lesser risk with extra ocular route

( systemic and local )

Pathophysiology Exact pathophysiology is unknown. But its known that IOP is elevated secondary

due to increased outflow resistance of aqueous humor due to the accumulation of these substance and blockage of the aqueous outflow.

1. Increase accumulation of glycosaminoglycan's. 2. Increase collagen, elastin and fibronectin. 3. Steroids also suppress phagocytic activity.

Sign & symptoms

With steroid-induced glaucoma, the pressure elevation is gradual. Therefore, like primary open-angle glaucoma, very few symptoms exist like:

IOP increase, cupping of disc, nasal field defect, scotoma, blindness, normal gonioscopy, (+) provoke test.cataract may be present.

Deferential DX Primary Open angle glaucoma PACG Infantile glaucoma Other types of glaucoma

Final DX: History of steroid use.

Management & TreatmentMedicalstop of corticosteroids or use an alternative

agent (less powerful steroid or NSAID) patient's IOP does not normalize upon

cessation of the steroid or in those patients who must continue on corticosteroid medications, use standard antiglaucoma medications ( pilocarpine, beta blocker )

Management & Treatment(…)Surgical When medical therapy is ineffective or the patient is intolerant

of medical therapy, then surgical therapy is indicated. In patients with an open angle and the absence of ocular

inflammation, argon laser trabeculoplasty can be attempted. In patients whom both medical and laser therapy have failed ,

surgical therapy is warranted. Usually, trabeculectomy (guarded filtration procedure), with or without intraoperative antimetabolites, is the primary procedure. In cases of eyes with active neovascularization or inflammation, a glaucoma drainage implant may be used as the primary procedure.

Questions ?