Year : 1981 | Volume
: 29 | Issue : 4 | Page : 377--379
Corticosteroid induced glaucoma and cataract
A Panda, NN Sood, LP Agarwal
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi, India
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi 29
|How to cite this article:|
Panda A, Sood N N, Agarwal L P. Corticosteroid induced glaucoma and cataract.Indian J Ophthalmol 1981;29:377-379
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Panda A, Sood N N, Agarwal L P. Corticosteroid induced glaucoma and cataract. Indian J Ophthalmol [serial online] 1981 [cited 2021 Jan 21 ];29:377-379
Available from: https://www.ijo.in/text.asp?1981/29/4/377/30935
The condition of raised intra-ocular pressure and cataract following the use of corticosteroids, is well known. The more potent steroids cause a higher incidence of increased intra-ocular pressure than those that penetrate the eye in poorer concentration. Flourometholone and Medrysone have little tendency to produce ocular hypertension,.
MATERIALS, METHODS AND OBSERVATIONS
Forty eight eyes of 24 patients who were prescribed local corticosteroid drops for local eye conditions elsewhere, and attended the hospital either with visual problems or for check up and were found to have raised I.O.P. with or without cataract. The age group of the patients varied from 7-68 years [Figure 1]. All subjects had the history of application of drug from six months to more than five years.
Careful ocular examinations, Schiotz and applanation tonometry, electronic tonography and gonioscopy, family study of the cases have been performed as far as possible. None of these cases had family history positive for glaucoma. The steroid evere stopped and medical therapy or even surgical therapy was planned in some cases.
Pure cortisone glaucoma is defined as that condition which is found if corticosteroids are applied locally in the cases of chronic eye diseases which themselves never cause glaucoma.
The steroid induced glaucoma may present as chronic or acute cases. Only two of our cases came with acute symptoms.
With "Mild Corticosteroids" the glaucoma appear within 6-12 months with potent steroid it may appear early within few weeks. One third of normal individuals may develop a corticosteroid induced ocular hypertension and subsequently after a long treatment develop glaucoma. Although a chronic corticosteroid glaucoma may present with same signs as an open angle glaucoma, it often has some special chracteristics.
The first step in the maragement is to stop the local corticosteroids and forewarn the patient about the further use of this drug [Figure 2],[Figure 3]. Initially miotics in lower concentration tried and increased if there is no response to lower concentration. It has been observed during our study that those patients who already had developed cataractous changes their visual acuity dropped with miotics. Further miotics are known to produce spasm of accommodation in younger age group 50% of our cases were young and thus it was considered better to try the adrenergic group of drugs. Epitrate is available in 2% and most of our patients needed either 1 % or ½% Epitrate for control of I.O.P. This drug not only reduced the I.O.P., but also relieves the symptoms of the conjunctival allergy. Slight dilation of the pupil with 1 % epitrate is an advantage in cases with cataract [Figure 4].
Out of 48 eyes, 9 eyes needed surgery and the surgical procedures are mostly in form of trabeculectomy. One eye had combined trabeculectomy and curette evacuation and another case required curette `evacuation at a later date.
48 eyes of corticosteroid induced glaucoma are analysed, allergic conjunctivitis is found to be the most common cause (70%) for which topical corticosteroids were used, 50% of our cases were less than 30 years. Incidence of cataract in these cases is 35%, 6 & 3 eyes were so much advance, that a cataract extractions are performed. Normalisation of I.O.P. occurs in 56% of cases after stopping local steroids. 25% of eyes are controlled with medical therapy (Miotics and/or epitrate). Adrenergic group of drugs (epitrate) have an edge for these not only reduce the I.O.P. but also relieves the local allergic symptoms and help in improving the visual acuity in cases with associated cataract, 19% of eyes needed surgery for control of I.O.P.
|1||Kitazawa, Y., 1976, Sixth Afro Asian Congress of Ophthalmol 234.|
|2||Spaeth, G.L. and Ludwig Von Sallmann, 1966, Int. Ophthalmol clinic Corticosteroid and eye. Little Brown Comp., 915.|
|3||Goldmann, H., 1966, lat. Ophthalmol clinic. Corticosteroid and eye, Little Brown Comp. 99.|