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Steroid-induced glaucoma
Glaucoma
Key Points
- •Steroid-induced glaucoma is a secondary open-angle glaucoma caused by increased TM outflow resistance from corticosteroid exposure via any route - it is potentially reversible if caught early
- •Approximately 5% of the population are high steroid responders (IOP rise >15 mmHg), 33% moderate, and 62% low - but ~90% of POAG patients are moderate-to-high responders (Armaly–Becker)
- •IOP-raising potency hierarchy: dexamethasone > prednisolone > fluorometholone > rimexolone > loteprednol - use the lowest potency for the shortest duration possible
- •The MYOC gene (myocilin / TIGR) is strongly upregulated by steroids in TM cells, and its mutations account for 3–5% of POAG - a direct molecular link between steroid response and POAG
- •Management: stop/switch steroid → anti-glaucoma medications → surgery if needed; always monitor IOP at 2–4 weeks after starting topical steroids
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17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations