Various medications may increase intraocular pressure (IOP), which may be via an open angle mechanism or a closing angle mechanism. Steroid induced glaucoma is a form of open-angle glaucoma that is normally associated with the topical use of steroids. However, it may develop with inhaled, oral, intravenous, periocular or intravitreal steroid administration.
Drugs prescribed for a variety of systemic diseases (eg, depression, allergies, Parkinson's disease) can cause dilation of the pupil and induce acute angle-closure glaucoma in anatomically predisposed narrow-angle eyes. It has also been reported that dietary supplements trigger acute narrow-angle glaucoma.
Q: I have a patient whose dermatologist prescribed a face and eyelid steroid cream. Should I worry about a possible steroid IOP response? What should I tell the dermatologist?
A: This well-known sentence applies here: it is not unusual for him to sit in your chair. The bottom line is that every time you use steroids around the eye, there is always the possibility of transdermal absorption, says Randall Thomas, O. D., of Concord, N.C.
Although secondary ocular hypertension due to a steroid lid cream is unlikely, he says: "It is possible that sufficient drug is absorbed into the eye in sufficient quantities to increase intraocular pressure in a steroidal responder.
According to a report from three such cases, topical corticosteroids applied to the face and eyes under dermatological conditions are often considered harmless with respect to ocular side effects. [However, secondary open-angle glaucoma can be a disease-threatening consequence. Periorbital steroids should therefore be used with caution and sparingly, especially in glaucoma family patients. Intraocular pressure may not return to normal after stopping the medication
Dermatologists routinely prescribe steroid skin creams for the chronic treatment of many dermatoses, especially in severe atopic eczema. Know the similarities, such as Dermatop (Prednicarbate, Dermik Labs), Clobetasol, and Fluocinonides, to the extent that you recognize their potential danger.
A case report described a 29-year-old woman who used strong topical steroids for long periods of her life in severe eczema, including the periorbital area.2 After such a month's use, she consulted her ophthalmologist for severe eye bilateral glaucoma and irreversible vision loss due to steroid application
How an ocular hypertensive reaction to an eyelid ointment actually works remains unclear. The response could be related to the systemic absorption of corticosteroid through the skin of the eyelid.3 Alternatively, a sufficient amount of ointment could seep across the eyelid and onto the ocular surface to cause an increase in intraocular pressure, similar to the use of topical ophthalmic corticosteroids. 3
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