Dexamethasone induced glaucoma as part of chemotherapy for lymphoblastic lymphoma and colorectal cancer

Abstract

PurposeTo describe glaucoma in an 11‐year‐old girl and exacerbation of glaucoma in a 59 year old man after high dose oral corticosteroid chemotherapy.MethodsTopical steroids are well known to cause intraocular pressure (IOP) elevation, but oral steroids are less commonly associated. We report 2 cases of significant IOP elevation after high dose dexamethasone treatment as part of chemotherapy for lymphoblastic lymphoma in an eleven‐year old girl, and for metastatic colorectal cancer in a 59‐year old man.ResultsA week after induction with dexamethasone combination chemotherapy an 11‐year old girl presented with headaches, photophobia and blurring of vision. Intraocular pressures were 48 and 52 mmHg in the right and left eye respectively with bilateral arteriolar disc pulsation. Control of IOP was achieved through topical and systemic treatment but requiring renal support after systemic carbonic anhydrase inhibitor use. The second patient was an adult male with preexisting glaucoma controlled medically in the right eye and with an aqueous shunt in the left eye. During the course of chemotherapy with systemic dexamethasone for colorectal cancer he presented to casualty with reduced right vision from 6/12 to 6/60 associated with an IOP of 42 mmHg in the right eye, while the left was 21 mmHg. His right eye required cyclodiode laser for IOP control.ConclusionsThese cases illustrate that high dose systemic dexamethasone treatment for chemotherapy may cause a considerable rise in IOP potentially leading to significant visual loss from glaucoma. This possibility should be anticipated especially in children and in patients with pre existing glaucoma who are at higher risk of steroid responsiveness.