Steroid-induced Glaucoma 33 Steroid-induced Glaucoma

Steroid-induced glaucoma is a form of open-angle glaucoma occurring as an adverse effect of corticosteroid therapy.1 It is usually associated with topical steroid use, but it may develop with oral, intravenous, inhaled, or periocular steroid adminis-tration by causing decrease in aqueous outflow facility. A number of drugs have been implicated in corticosteroid-induced glaucoma including dexamethasone, betamethasone, predni-solone, medrysone, fluoromethalone, hydrocortisone, cortisone, etc. Glucocorticoids may exert their effect by increased expression of the MYOC (TIGR) gene at Locus GLC1A.2 INCIDENCE Steroid-responsive intraocular pressure (IOP) elevations can occur in people of all ages, although children are less frequently reported to have IOP elevation with steroids.3 No gender and racial predilection exists for steroid-responsive glaucoma. Incidence of steroid-induced IOP elevation in patients on systemic corticosteroids is unknown because most of these patients do not have their IOP checked. These patients may be discovered during a routine eye exam while on medication, or the glaucoma may have progressed to the point of causing visual symptoms. Patients taking topical steroid drops usually receive follow-up care by an ophthal-mologist who monitors IOP. Approximately one-third of individuals experience moderate increase in IOP after topical steroid use. However, 5-6 % of normal population develops a marked increase of IOP after 4-6 weeks of topical steroid therapy.4-7 Thus, 5 % of the general population is considered to be “steroid responder”, i.e. may develop steroid-induced glaucoma when steroids are administered. This is shown by studies conducted by Armaly and Becker (Table 1)