The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Steroid-related Ocular Hypertension and Glaucoma results from elevated intraocular pressure (IOP) due to the therapeutic use of glucocorticoids. Patients do not usually experience symptoms in the early stages and, if unidentified, the condition can lead to steroid-induced glaucoma and irreversible optic neuropathy. 75% of cases are due to topical steroid applications. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and managing steroid-related ocular hypertension and glaucoma. It provides recommendations for non-pharmacological management and pharmacological treatment, and outlines when urgent referral may be appropriate.
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What is steroid-related ocular hypertension and glaucoma?
When some patients are treated with steroids (as eye drops, tablets, injections, implants) it can cause the pressure inside their eye to rise. 35% of the population are at risk of developing this problem. As the raised pressure does not usually cause symptoms, the patient may be unaware that the eye pressure is rising and if not identified can lead to glaucoma. Glaucoma is a disease in which raised eye pressure can damage the nerve fibres of the retina (the light-sensitive layer at the back of the eye) and cause selective but irreparable loss of the eye’s field of vision. Patients newly begun on steroid therapy should ideally have their eye pressures checked regularly.
How is steroid-related ocular hypertension and glaucoma managed?
Stopping the steroid that causes the condition, if this is appropriate, usually allows the eye pressure to return to normal. If this does not happen, the condition may have to be treated as if it were an ordinary case of glaucoma (of the type known as ‘open angle’), using eye drops or possibly laser treatment or surgery.