Effect of steroid therapy on intraocular pressure

Abstract

Glucocorticosteroids are key anti-inflammatory agents in the treatment of ophthalmic and systemic inflammatory diseases. However, prolonged use may result in an increase in intraocular pressure followed by a potentially vision -threatening ocular complication as glaucomatous neuropathy ultimately leading to blindness. Steroid therapy can increase intraocular pressure not only with ophthalmic preparations, but also with other routes of administration such as inhalational, intranasal and systemic. The aim of this paper is to provide a summary of the etiology, diagnosis, and treatment options for steroid-induced iatrogenic glaucoma, based on key literature findings and our own clinical experience, with a detailed comparison of different corticosteroid treatments. The application of steroid therapy can be avoided in a small number of medical fields, so it is crucial that where prolonged steroid therapy is required, all physicians should consider the intraocular pressure-enhancing effects of steroids. The intraocular pressure-increasing effect of steroids depends on the type of active substance, the route of administration and the time of administration. Regardless of the application of a certain medical field, regular ophthalmic examination is necessary, especially with a history of glaucoma, as persistent elevations in intraocular pressure can cause irreversible damage to ganglion cells and optic nerve fibers, ultimately leading to blindness. The difficulty in recognizing the complication is exacerbated by the fact that the intraocular pressure usually rises asymptomatically and painlessly. When steroid therapy cannot be avoided, the least possible intraocular pressure-increasing agent should be selected for the shortest possible dosage at the lowest possible dose. If the increase in intraocular pressure cannot be controlled conservatively, a surgical solution may be considered.