Steroid-Induced Eye Pressure Elevation and Glaucoma Risks

Steroid-induced ocular hypertension

Hello Doctor, in early April, I visited a clinic due to conjunctivitis and was suspected to have glaucoma; at that time, my intraocular pressure was 18 in both eyes.
I then went to two major hospitals for further examination, where glaucoma was ruled out, and it was determined that I have high myopia, so they suggested monitoring.
However, at the hospitals, my intraocular pressure mostly ranged from 20 to 22.
I would like to ask: 1.
Given that I have had regular check-ups at a small clinic over the years with intraocular pressure mostly around 17-18, can anxiety significantly raise my eye pressure? 2.
Does wearing stronger prescription glasses for high myopia and astigmatism increase intraocular pressure? 3.
Recently, I returned to the clinic for conjunctivitis and was prescribed steroids to use four times a day for a week.
Upon follow-up, I found that the intraocular pressure in my left eye spiked to 28.
The doctor advised monitoring, but the next day, I went to a nearby ophthalmologist and it decreased to 22.
On the third day, it further decreased to 19, and I was not prescribed any intraocular pressure-lowering medication, only artificial tears.
I read online that steroid use can raise intraocular pressure, especially in individuals predisposed to glaucoma.
Does the decrease in pressure indicate that I shouldn't be overly concerned? How should I monitor this situation more safely? Additionally, would you recommend using intraocular pressure-lowering eye drops? Thank you for your response.

Amber, 20~29 year old female. Ask Date: 2022/06/11

Dr. He Jianxian reply Ophthalmology

1.
Currently, most devices used to measure intraocular pressure are non-contact tonometers, which can yield elevated readings due to patients blinking from anxiety during the measurement.
2.
Theoretically, over-correcting refractive errors can lead to increased eye fatigue; however, there are no clear clinical reports indicating that this also raises intraocular pressure.
3.
Prolonged and excessive use of steroid eye drops may lead to increased intraocular pressure, but it is rare for pressure to rise after just one week of use.
If intraocular pressure returns to normal after discontinuation of the medication, it typically does not require treatment with pressure-lowering medications.
Dr.
He Jianxian, Ophthalmology Department, Nantou Hospital.

Reply Date: 2022/06/11

More Info

Steroid-induced eye pressure elevation is a significant concern in ophthalmology, particularly for patients with pre-existing conditions or those at risk for glaucoma. Your situation highlights several important aspects regarding eye pressure, the effects of steroids, and the management of potential glaucoma risks.

1. Impact of Anxiety on Eye Pressure Measurements: It is well-documented that anxiety and stress can lead to temporary increases in intraocular pressure (IOP). When patients are nervous during an eye exam, they may inadvertently tense their eye muscles or blink more frequently, which can affect the accuracy of the pressure readings. Therefore, it is possible that your previous measurements of 17-18 mmHg could have been influenced by a more relaxed state compared to the more recent readings of 20-22 mmHg. Regular monitoring in a calm environment can help provide a more accurate assessment of your baseline eye pressure.

2. Effect of High Myopia and Glasses on Eye Pressure: High myopia (nearsightedness) itself does not directly cause elevated eye pressure. However, the use of glasses with stronger prescriptions or larger frames may lead to visual discomfort or strain, which could indirectly affect your perception of eye pressure. It is essential to ensure that your prescription is accurate and that your glasses fit well to minimize any potential strain on your eyes.

3. Steroid Use and Eye Pressure: The use of topical steroids, especially over a short period, can lead to significant increases in IOP in some individuals. Your observation of an increase to 28 mmHg after one week of steroid use is concerning but not uncommon. The fact that your pressure decreased to 22 mmHg and then to 19 mmHg in subsequent measurements is reassuring. It suggests that the elevation may have been temporary and related to the steroid use. If your eye pressure stabilizes and returns to normal levels after discontinuing the steroids, it is generally a good sign that you may not require additional pressure-lowering medications. However, close monitoring is essential.

4. Monitoring and Follow-Up: Given your history and the recent fluctuations in eye pressure, regular follow-up appointments with your ophthalmologist are crucial. They may recommend periodic IOP checks, visual field tests, and possibly imaging studies to monitor the health of your optic nerve. If your pressures remain elevated or if there are signs of optic nerve damage, your doctor may consider prescribing pressure-lowering medications.

5. Understanding Glaucoma Risk: The concern about having a predisposition to glaucoma due to steroid use is valid. Individuals with a family history of glaucoma or those who have experienced elevated IOP in the past are at higher risk. However, the fact that your pressures have decreased after stopping the steroids is a positive indicator. It is essential to maintain open communication with your ophthalmologist about any symptoms you experience and to adhere to the follow-up schedule they recommend.

In summary, while steroid-induced eye pressure elevation can pose risks, your recent pressure readings suggest that your condition may be stabilizing. Regular monitoring and follow-up with your eye care provider will be key in ensuring your ocular health. If you have any concerns or experience new symptoms, do not hesitate to reach out to your ophthalmologist for guidance.

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