Good Hope, Heartlands, and Solihull Eye Clinics

Steroid induced glaucoma

notes David Kinshuck after a talk by Anil Negi


  • 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: osardex   Eye 20  However, IOP>2 mmHg was recorded in 14%, 28% and 27% in White, Latino, and South Asian groups, respectively. Incidence of very high IOP (>35mmHg) was lower in all geographical groups. It was 3% in Latino followed by 2% in South Asian group.

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.