Glaucoma
Steroid-Induced Glaucoma
Also known as: steroid response, steroid responder, steroid-induced glaucoma, steroid induced ocular hypertension, steroid glaucoma, corticosteroid pressure rise, steroid IOP spike
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Corticosteroids increase resistance to aqueous outflow in the trabecular meshwork and can raise the intraocular pressure. The angle is open. The rise is usually seen days to weeks after the steroid is started, though a late rise can occur. A raised pressure without nerve damage is a steroid response; with glaucomatous damage it is steroid-induced glaucoma. The risk follows the route (intravitreal, then periocular, then topical, then systemic), the potency (dexamethasone more than prednisolone, more than fluorometholone), the dose and the duration. The patient feels nothing, so the pressure must be measured.
Recognition
Symptoms: what patients report
- Usually none
- Symptoms of the condition the steroid was given for
- Blur or haloes only when the pressure is very high
Signs: what the examination shows
- Raised intraocular pressure compared with the pre-steroid baseline
- Open angle on gonioscopy, with any signs of the condition being treated
- A slit-lamp examination that is unremarkable apart from the condition being treated, such as anterior uveitis or allergic conjunctivitis
- Glaucomatous disc, nerve fibre layer or field change in established steroid-induced glaucoma
What OptoGuide™ covers for steroid-induced glaucoma
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting