Steroids have many benefits, particularly in the treatment of inflammatory and autoimmune conditions. Unfortunately, they have several potential side effects, some of which can be serious. Certain eye conditions, such as cataracts and steroid-induced glaucoma, are among these adverse effects. Learn what steroid-induced glaucoma is, what causes it, what symptoms to look for, and how it can be treated.* 

What Is Steroid-Induced Glaucoma?

Experts call steroid-induced glaucoma a type of secondary open-angle glaucoma. Open-angle glaucoma is caused when aqueous humor (a fluid made in your eye) is blocked from draining out. The buildup of fluid makes the pressure inside your eye (IOP) increase. The higher IOP damages your optic nerve, eventually causing vision loss. 

Aqueous humor usually drains through a structure in your eye called the trabecular meshwork. The problem occurs when this structure is clogged, whether by particles that shouldn’t be there, or by a deformity, or for some other reason. Steroid-induced glaucoma can occur after steroid use by people who have a steroid sensitivity.

What Causes Steroid-Induced Glaucoma?

Your trabecular meshwork cells have receptors for glucocorticoids, steroid hormones that help your body turn proteins, fats, and carbohydrates into energy. Steroids can bind to these receptors, and start a process that:

• Increases the production (and deposit) of particles, and 
• Decreases the drainage of your aqueous humor.

If the pressure from the lack of drainage gets high enough, and lasts long enough, it can harm your optic nerve and, over time, lead to loss of your eyesight.

Steroid-induced glaucoma can occur after using steroids in the form of:

• Pills
• Eye drops
• Topical skin creams
• Nasal sprays or rinses

Problems are seen most often after eye drop use, with increased IOP occurring within three to six weeks. Steroid injections may take a few months to cause noticeable IOP changes.

Who Is at Risk for Steroid-Induced Glaucoma?

People who experience an increase in IOP after using steroids are called “steroid responders”. Risk factors for high responsiveness include a personal or family history of:

• Older age
• Diabetes
• Primary open-angle glaucoma 
• Extreme nearsightedness
• Connective tissue disorders like rheumatoid arthritis

If you are a steroid responder, you may be at risk whether you use steroids at home, receive them during treatment for autoimmune or inflammatory conditions, or are given them after surgery. Renal transplant patients are also at risk.

What Are the Symptoms of Steroid-Induced Glaucoma?

Like primary open-angle glaucoma, steroid-induced glaucoma is often asymptomatic until it has progressed pretty far, and might only be detected by an ophthalmologist after several different tests. Once optic nerve damage is severe, you may notice blurred peripheral (side) vision. Even that may go unnoticed in your day-to-day life, so keeping up with routine eye exams is critical for good eye health.

Open-angle glaucoma is not painful. If you have pain in your eye, brow, or head, whether sudden or chronic, you may need to be tested for another condition. One form of glaucoma called angle-closure glaucoma, can cause sudden, severe pain, and requires immediate medical attention in order to prevent blindness. 

How Is Steroid-Induced Glaucoma Treated?

The first step in treating steroid-induced glaucoma is generally to wean off steroids. If, for medical reasons, you can’t stop them completely, your doctor may be able to lower your dosage or give you a weaker version. Antiglaucoma drugs may also be prescribed. 

The three main treatments that your doctor may explore with you are:

• Medications. Open-angle glaucoma is often managed with blood pressure drugs, and/or medicated eye drops called prostaglandin analogs. The drops are not recommended for steroid-induced glaucoma if you’ve had treatment for uveitis.
• Laser therapy. Minimally-invasive laser therapy works for many people who can’t tolerate the medications, or for whom they don’t work sufficiently. 
• Surgery. Most doctors consider surgery as a last resort for treating glaucoma. If it’s deemed necessary, there are a variety of surgical options available, including:
  • Trabeculectomy,
  • Tube shunt surgeries, and
  • Cyclodestructive procedures. 

Additional types of laser therapies and surgeries are available to treat other forms of glaucoma.

What Is the Outlook for Patients with Steroid-Induced Glaucoma?

While steroid-induced glaucoma is serious and can potentially lead to vision loss and eventual blindness, your prognosis is likely to be good if the problem is detected early and properly treated. 

*Feroze, K. B., and Khazaeni, L. (2022, Jan. 2). Steroid Induced Glaucoma. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430903/