39 EyeWorld Asia-Pacific | June 2025 GLAUCOMA Steroid-induced glaucoma can present a number of issues, most notably increased IOP. Several physicians discussed identifying when and why this occurs and how to react to improve the pressure. Malik Y. Kahook, MD, noted that the exact incidence of steroid-induced glaucoma depends on the patient population and the type of steroid used. “Reports suggest that up to one-third of the general population are at least moderate ‘steroid responders,’ showing a significant rise in IOP with steroid use, though only a small subset develops clinically significant glaucoma. The incidence increases in high-risk groups, such as individuals with preexisting glaucoma or a strong family history of the condition,” he said. Rebecca Chen, MD, said that it is estimated that 5% of the population is considered susceptible to developing increased eye pressure with steroid exposure. “Elevated eye pressure does not always lead to steroid-induced glaucoma (defined as optic nerve damage) if it is diagnosed and treated in time,” she said. Robert Noecker, MD, added that steroid-induced glaucoma is a problem that he sees quite frequently. “It’s something I see probably every other week,” he said. “I think the most common setting is when patients are put on steroids for surgery, like for cataract surgery.” Because cataract surgery is a common surgery, that’s when it’s most likely to pop up, and he also noted that many of his patients already have glaucoma, they’re a higher-risk population. Signs And Symptoms “It’s one of those things you often have to look for,” Dr. Noecker said. Some patients may be symptomatic, but others may not. They might have a headache, or vision might be getting blurry a week or so after cataract surgery. “That’s why we have to check the pressure,” he said; the patient might seem fine, but the pressure could be 40. One diagnostic clue is the magnitude of the increase. “It’s not like their pressure went from 15 to 20; it’s like it went from 15 to 45. The common setting is a couple weeks of being on steroids,” he said. Dr. Kahook said that steroid-induced glaucoma typically “presents with an insidious rise in IOP.” He also noted that patients are often asymptomatic until the IOP is significantly elevated or optic nerve damage occurs. In cases where symptoms arise, patients may report blurred vision, halos around lights, or eye discomfort. Ophthalmologists should monitor for progressive optic nerve cupping, visual field defects, and elevated IOP during follow-up, he said. Steroid-induced pressure elevation may occur within days to weeks of starting treatment, depending on the route of administration. Topical steroids usually have a quicker onset of IOP elevation (within 2–6 weeks) compared to systemic or inhaled forms, which may by Ellen Stodola, Editorial Co-Director Identifying And Handling Steroid-Induced Glaucoma
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