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Republished case report
Steroid-induced glaucoma: an avoidable cause of irreversible blindness
  1. Benjamin H K Teo1,
  2. Jonathan T W Au Eong2,
  3. Kah Guan Au Eong234
  1. 1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  2. 2 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  3. 3 International Eye Cataract Retina Centre, Mount Elizabeth Medical Centre and Farrer Park Medical Centre, Singapore
  4. 4 Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
  1. Correspondence to Dr Kah Guan Au Eong; aueongkahguan{at}gmail.com

https://doi.org/10.1136/dtb.2024.e254709rep

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    In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.

    Summary

    A man in his 70s on regular follow-up with an ophthalmologist for 10 years presented with blurry vision in his right eye for 4 days. He was diagnosed with elevated intraocular pressure (IOP) bilaterally 18 months earlier and treated with antiglaucoma eye-drops. On direct questioning, he admitted to using fixed combination tobramycin 0.3%/dexamethasone 0.1% eye-drops frequently to relieve ocular redness and discomfort in both eyes for 3.5 years without his ophthalmologist’s knowledge. Examination disclosed markedly elevated IOP, advanced optic disc cupping and tunnel vision due to steroid-induced glaucoma bilaterally. After cessation of the eye-drops and 2 weeks of antiglaucoma therapy, his IOP returned to normal and his visual field remained stable for 4 years.

    Our case highlights the danger of habitual self-treatment of prescription medications containing corticosteroids and the importance of taking a detailed medication history in the diagnosis and management of steroid-induced glaucoma.

    Background

    Topical corticosteroids are a class of anti-inflammatory drugs commonly used to treat various ocular disorders. Individuals who respond to corticosteroids with intraocular pressure (IOP) elevation are called ‘steroid responders’. Elevation of IOP as a result of corticosteroid use is called steroid-induced ocular hypertension.1 If the IOP elevation is of sufficient magnitude and is not treated, glaucomatous optic neuropathy can develop, resulting in visual loss and blindness (steroid-induced glaucoma).1

    Steroid-induced glaucoma is a form of secondary open-angle glaucoma.1 Its clinical presentation is like primary open-angle glaucoma (POAG), except perhaps with a higher IOP.1 There is heavy accumulation of type …

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: BHKT, JTWAE and K-GAE. The following authors gave final approval of the manuscript: BHKT, JTWAE and K-GAE.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.