Synopsis
Recognise silent pressure elevation associated with corticosteroids, establish an appropriate monitoring plan and coordinate safe steroid adjustment with treatment that protects the optic nerve.
- Steroid-induced ocular hypertension is raised pressure related to corticosteroid exposure; steroid-induced glaucoma additionally involves established optic nerve damage.
- Pressure elevation is often symptomless, so monitoring should be planned when treatment is started and revisited after dose or route changes.
- Ask about eye drops, ointments, periocular and intravitreal treatment, oral therapy and other steroid exposure rather than relying on the current eye-drop list alone.
Key red flags
New pain, redness or blurred vision after an intravitreal steroid injection requires immediate contact with the treating eye service; do not assume the symptoms are a routine steroid pressure response.
Investigation priorities
Confirm the rise and look for its mechanism and current severity.
Management branches
A steroid course is being started, intensified or continued in a person with potential ocular risk.
- Record the indication and expected duration, review previous pressure responses and glaucoma history, and establish baseline ocular information appropriate to the planned treatment.
- Agree who will check pressure and when, taking account of formulation, intensity, patient risk and the relevant SmPC rather than applying a generic annual interval.
Key medicines
Dorzolamide 20 mg/mL for suitable pressure reductionThe selected dorzolamide product uses a single drop in each affected eye three times a day when prescribed alone, or twice a day as adjunctive therapy to an ophthalmic beta-blocker; continue to the specified pressure review.