a brief review of steroid induced glaucoma

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

4. 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.

5. 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 )

6. 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.

8. 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.

11. Deferential DX
 Primary Open angle glaucoma
 PACG
 Infantile glaucoma
 Other types of glaucoma
 Final DX: History of steroid use.

12. Management & Treatment
 Medical
 stop 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
)

13. 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.

14. Questions ?