Good Hope, Heartlands, and Solihull Eye Clinics

Steroid induced glaucoma

notes David Kinshuck after a talk by Anil Negi

Abbreviations

  • IOP = intraocular pressure
  • tm = trabecular meshwork

Glaucoma can be caused by steroid drops or steroid implants used in the treatment of eye conditions.
If using steroid drops or steroid implants

  1. 5% severe
  2. 33% some IOP rise
  3. if the patient has glaucoma, 90% will get a pressure rise.
  4. it is more common in high myopes
  5. it is more common in POAG glaucoma relatives: 60% will get a pressure rise
  6.  Younger or older patients, patients with connective tissue disease, diabetes, all have increased risk of pressure rise with steroid treatment
  7. see steroid implants

Steroids increase extracellular matrix and reduced phagocytosis in the trabecular meshwork.
Myocillin expression in trabecular meshwork is expressed, endothelin is expressed leading to contraction of extracellular beams .

Other steroids may put up the eye pressure and cause glaucoma

  1. skin creams used around the face for eczema: skin creams should not be used around the eyes if at all possible
  2. steroid tablets used in the treatment of many conditions: if steroid tablets are need for more than 4 weeks then the eye pressure should be measured at an opticians. SO measure the pressure at 4 and then every 12 weeks of steroid use.