Corticosteroid treatment for inflammatory bowel disease in pediatric patients increases intraocular pressure

Abstract

Intraocular pressure (IOP) was measured in 54 pediatric patients (aged 7–21 years) with inflammatory bowel disease (IBD) who were treated with oral prednisone for 1–104 months. The difference in mean IOP between the treated patients (mean ± SD, 15.62 ± 4.11 mm Hg) and 55 age-matched controls (13.83 ± 2.42 mm Hg) was statistically significant (P = 0.007). The IBD patients were classified as group I, IOP ≤19 mm Hg in both eyes, and group II, IOP ≥ 20 mm Hg in either eye. Twelve of the 54 patients (22.2%) and none of the controls had IOP ≥ 20 mm Hg (P < 0.001). Seventeen of the 54 patients (31.5%) were characterized as “steroid responders” (IOP of ≥ 20 mm Hg, change in IOP of ≥ 6 mm Hg between visits, or difference in IOP of ≥ 6 mm Hg between the two eyes). When the dose of prednisone was reduced to 0–10 mg/day 30 days or more before measurement, 9 steroid responders showed a decrease in IOP to within 2 SD of the mean control IOP; 7 of the 9 showed a decrease in IOP of ≥ 6 mm Hg. These observations indicate that while prednisone is a causative factor in increasing the IOP, susceptibility to average doses of prednisone is highly variable, and patients need to be monitored on an individual basis. Because IBD is a chronic disorder that requires prolonged corticosteroid treatment, these children are at risk of developing steroid-induced glaucoma. Careful ophthalmologic monitoring of pediatric IBD patients, as well as of other pediatric patients who receive corticosteroid therapy, is recommended.