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Closely monitor children for steroid-induced glaucoma
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Researchers recommended that eye care providers reconsider topical steroids for children as a primary treatment option or monitor them closely, in a study recently published in the British Journal of Ophthalmology.
Gupta and colleagues analyzed the records of pediatric glaucoma cases that had been presented at their clinic in India over the course of 5 years.
Researchers noted highest baseline intraocular pressure, perimetry, visual acuity, need for glaucoma filtering surgery and the cup-to-disc ratio of children who were diagnosed with steroid-induced glaucoma (SIG). They also interviewed parents to determine steroid usage.
Results showed that 59 children had steroid-induced glaucoma, out of 1,259 cases of pediatric glaucoma. Of those 59 children, 51 had initially been prescribed topical steroids to treat vernal keratoconjunctivitis. Researchers reported that median length of steroid use was 18 months.
"A third of the children presenting with SIG at our tertiary care center were bilaterally blind at presentation, and a third were blind in one eye," the authors wrote. "Surprisingly ophthalmologists were responsible for the over-prescription of steroids in the majority of children. Some children had used the steroid drops for long periods of up to 8 years before being diagnosed with advanced glaucoma, despite following up regularly with their ophthalmologist."
The authors stressed that more conservative options should be considered as first-line treatments and that guidelines for prescribing steroids and monitoring IOP should be established. – by Chelsea Frajerman Pardes
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Blair Lonsberry, OD, FAAO
Topical steroids have a known potential side effect of increasing a patient’s IOP. Steroid-induced elevation of IOP is also known to be more frequent in children.
Gupta and colleagues reviewed the pediatric glaucoma records in their practice and determined that 4.7% of these cases were secondary to the administration of steroids (both systemic and topical). Most steroid-induced glaucoma was secondary to long-term topical use of steroids to treat vernal keratoconjunctivitis, with an average steroid use at presentation of 18 months.
The authors report that many of these patients had received follow-up visits with the physician who prescribed the steroid. Dexamethasone 0.1% was associated with the majority of cases, followed by prednisolone 1%, fluorometholone 0.1% and loteprednol 0.5%.
It is evident that even with our “safer” steroids, such as fluorometholone and loteprednol, there is still a risk of elevated IOP with long-term use, and IOPs need to be monitored in all patients receiving steroid, especially children.
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