Did you know that glaucoma can come in two forms? These are primary glaucoma and secondary glaucoma. In primary glaucoma, the cause is unknown, but in secondary glaucoma, the cause of increased intraocular pressure can be pinpointed. The use of steroids can be one such cause of secondary glaucoma, known as steroid-induced glaucoma.

Steroids were introduced more than 100 years ago and have been used to treat a number of different medical conditions, such as eczema, asthma, and rheumatoid arthritis (RA). They can come in several forms:

• Over-the-counter (OTC) nasal sprays and topical creams
• Prescription steroids, including pills, inhalers, shampoo, joint injections, and ear drops

More than 60 years ago, steroid-induced glaucoma was recognized after a report showed a rise in IOP after the use of systemic adrenocorticotropic hormone (ACTH). Steroids can alter the aqueous humour (AH) outflow system, resulting in increased IOP. This change can occur within days or weeks. If increased eye pressure is not recognized as a side effect of the medication, steroid-induced glaucoma can occur and could lead to permanent damage.*

Risk factors for steroid-induced glaucoma

Eight percent (8%) of the general population suffers from steroid-induced glaucoma, but the condition is most common in patients with glaucoma and their blood relatives. In particular, the majority of people with open-angle glaucoma experience a steroid response. 

Other risks factors include:

• Advanced glaucoma
• Family history of glaucoma (especially in a first-degree relative)
• Of African American descent
• Previous steroid response
• Use of stronger steroids
• Diabetes
• High myopia
• Connective tissue disease (e.g., rheumatoid arthritis)
• Inflammatory glaucoma (occurs in 10-21% of patients)

These high-risk individuals should avoid steroids unless necessary to prevent damage to eye health. Fortunately, for most people who have been affected, discontinuation of steroids can help to stabilize eye pressure.

On the other hand, patients who have repeated exposure to steroids could experience permanent eye damage. Terry Pickering, M.D., an ophthalmologist in San Francisco, explains that “every week of steroid use averaged over a lifetime leads to a 4% increased risk of chronic steroid glaucoma.”

Because steroids are used to treat a gamut of medical conditions, it’s important to consult your prescribing physician and your ophthalmologist to ensure steroids are the best choice for you or if other non-steroidal options would be less risky.

*Pickering, T. (2020, Oct. 22). Steroids and Glaucoma: What’s the Connection? Glaucoma Research Foundation. https://www.glaucoma.org/glaucoma/steroids-and-glaucoma-whats-the-connection.php

Any sources from outside of Prevent Blindness do not imply an endorsement from Prevent Blindness. The contents of the material used are the responsibility of the authoring organization, Responsum Health.