Glaucoma corticosteroids

Francois J, Benozzi G, Victoria-Troncoso V, Bohyn W. Ultrastrnctnral and morphometric stndy of corticosteroid glaucoma in rabbits. Ophthalmic Res 1984 16 168-178. 

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Budesonide, Oral (Entocort EC) [Anti-inflammatory> Corticosteroid] Uses Mild-mod Crohn Dz Action Steroid, anti-inflammatory Dose Adults. Initial, 9 mg PO qAM to 8 wk max maint 6 mg PO qAM taper by 3 mo avoid grapefruit juice Contra Active TB and fungal Infxn Caution [C, /-] DM, glaucoma, cataracts, HTN, CHF Disp Caps SE HA, cough, hoarseness, Candida Infxn, epistaxis Interactions T Effects W/ erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, grapefruit EMS Monitor ECG and BP for signs of electrolyte disturbances and hypovolemia OD Acute OD unlikely to cause a problem, chronic OD can reduce natural production of certain steroids symptomatic and supportive... 

The most commonly observed side effects associated with vidarabine are lacrimation, burning, irritation, pain, and photophobia. Vidarabine has oncogenic and mutagenic potential however, the risk of systemic effects is low because of its limited absorption. It should not be used in conjunction with ophthalmic corticosteroids, since these drugs increase the spread of HSV infection and may produce side effects such as increased intraocular pressure, glaucoma, and cataracts. 

McLean CJ, Lobo RF, Brazier DJ. Cataracts, glaucoma, and femoral avascular necrosis caused by topical corticosteroid ointment. Lancet 1995 345(8945) 330. 

Cystoid macular edema developed in two patients treated with topical latanoprost for glaucoma (23). Latanoprost was withdrawn, and the cystoid macular edema was treated with topical corticosteroids and ketorolac, with improvement in visual acuity. The macular edema resolved in both cases. 

Kersey JP, Broadway DC. Corticosteroid-induced glaucoma a review of the literature. Eye. 2006 20 407-416. 

A number of toxic effects on the blood have been documented, including agranulocytosis caused by chlorpromazine, hemolytic anemia caused by methyldopa, and megaloblastic anemia caused by methotrexate. Toxic effects on the eye have been noted and range from retinotoxicity caused by thioridazine to glaucoma caused by systemic corticosteroids. 

Corticosteroids should be used cautiously in the presence of congestive heart failure, myocardial infarction, hypertension, diabetes mellitus, epilepsy, glaucoma, hepatic disorders, osteoporosis, peptic ulceration, and renal impairment. Children are more susceptible to these adverse effects. To avoid cardiovascular collapse, steroids must be given slowly by intravenous injection. Large doses produce Cushing s syndrome (with moon face and sometimes hirsutism). 

Studies have investigated the pharmacoeconomics of drug therapy. The drug price may reflect only part of the medication cost. Other costs, such as those associated with adverse drug effects, additional laboratory tests, and office visits, may more realistically reflect the pharmacoeconomics of therapy. For ophthalmic medications, the daily cost of medications also depends on the volmne of the medication, the drop size, dosing regimen, compU-ance, and other fectors. PubUcations have reviewed glaucoma and topical corticosteroid therapy and described more cost-effective treatment options not based solely on the actual medication cost. 

After the introduction of corticosteroids for treating ocular inflammatory disease, reports began to appear in the literature that implicated topical steroid therapy as a cause of elevated lOP. In 1962 after reported observations with topical steroid therapy it became generally accepted that these agents can produce the clinical picture of open-angle glaucoma. 

Because side effects can complicate the use of corticosteroids, a careful history and certain tests may be advisable, particularly if a patient may require prolonged ocular therapy. Steroids should be used with great caution in patients with diabetes mellitus, infectious disease, chronic renal feilure, congestive heart feilure, and systemic hypertension. Systemic administration is generally contraindicated in patients with peptic ulcer, osteoporosis, or psychoses. Topical steroids should be used with caution and only when necessary in patients with glaucoma. 

Leibowitz HM, Ryan WJ, Kupferman A. Comparative antiinflammatory efficacy of topical corticosteroids with low glaucoma-inducing potential. Arch Ophthalmol 1S>92 110 118-120. 

Because intermediate uveitis does not involve the ciliary body or trabecular meshwork, lOP is rarely impacted by this disease course. However, should late-stage changes occur in the anterior chamber (e.g., synechiae, iris neovascularization), the clinician is obligated to perform tonometry and monitor for secondary glaucoma. Also, use of topical, injectable, and/or systemic corticosteroids in the treatment of uveitis may induce a precipitous rise in lOP, resulting in steroid-induced glaucoma. 

In most cases the treatment of these conditions involves both anti-inflammatory (typically topical corticosteroids) and antiglaucoma (typically aqueous suppressants) medications. Cycloplegics are used to prevent or manage posterior synechia, secondary neovascular glaucoma, and choroidal effusion. Miotics are typically avoided in the management of these conditions because their use... 

Corticosteroid administration by systemic (oral or intravenous), topical (ophthalmic and cutaneous), injected (periocular and subcutaneous), and inhalation and possibly nasal routes can elevate lOP In patients who are steroid responders, oral steroids produce approximately 60% the increase in lOP as compared with topical agents, most likely because of differences in achieved anterior chamber concentrations of the drug. Those with primary open-angle glaucoma respond to steroids at a rate of 46% to 92% compared with 18% to 36% of... 

Tripathi RC, Parapuram SK,Tripathi BJ, et al. Corticosteroids and glaucoma risk. Drugs Aging 1999 15 439-450. 

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