Steroid-Induced Glaucoma
Corticosteroids taken by any route — eye drops, pills, inhalers, nasal sprays, joint injections, or skin creams — can raise eye pressure in susceptible people, sometimes leading to glaucoma.
Overview
Steroid-induced glaucoma occurs when corticosteroid exposure raises eye pressure enough to damage the optic nerve. Steroids can reduce the outflow of fluid through the trabecular meshwork, and in susceptible people this can build up pressure over weeks to months of use, whatever form the steroid is taken in.
Symptoms
- Typically no symptoms at all — the pressure rise is usually silent
- Sometimes noticed only because eye pressure is checked during a routine visit while on steroid therapy
- In advanced or prolonged cases, gradual peripheral vision loss identical to other open-angle glaucomas
How Common Is It?
Roughly 30–40% of the general population shows some measurable rise in eye pressure with sustained steroid exposure ('steroid responders'), while a smaller subset, around 5%, are 'high responders' with a more dramatic rise.
The risk and speed of pressure rise depend heavily on the potency, dose, and route of the steroid: steroid eye drops are the fastest and most potent at raising pressure, while oral, inhaled, intranasal, and topical skin steroids carry lower but real risk, particularly with long-term or high-dose use.
Genetics & Risk Factors
A personal or family history of primary open-angle glaucoma substantially increases the likelihood of being a steroid responder, and variants in the myocilin (MYOC) gene — also implicated in some inherited forms of open-angle glaucoma — have been associated with a stronger steroid pressure response.
Other reported risk factors include high myopia, type 1 diabetes, and connective tissue disease, though the strongest and most consistent predictor remains a personal or family history of glaucoma.
Ocular Findings on Exam
The exam findings are often indistinguishable from typical open-angle glaucoma: an open drainage angle on gonioscopy, elevated pressure, and, if pressure has been high long enough, thinning of the optic nerve rim and nerve fiber layer.
The key diagnostic clue isn't found on the eye exam itself but in the history: a temporal relationship between starting or increasing a steroid (by any route) and a subsequent rise in eye pressure, usually appearing within weeks to a few months of exposure.
Testing & Diagnosis
- A thorough medication history covering every route of steroid exposure — eye drops, pills, inhalers, nasal sprays, skin creams, and joint or eye injections
- Serial IOP measurements correlated with the timing of steroid use
- Gonioscopy to confirm an open angle
- OCT of the optic nerve fiber layer and visual field testing to check for any damage
- A trial of stopping or switching the steroid, when medically feasible, to see whether pressure normalizes
Treatment Options
Stop or Switch the Steroid
When medically possible (in coordination with the prescribing physician), discontinuing the steroid or switching to a lower-impact option (such as a 'soft' steroid like loteprednol or fluorometholone for eye drops) is the most direct treatment and can fully resolve the problem.
IOP-Lowering Drops
When the steroid can't be stopped — for example, if it's needed to control a serious underlying condition — standard glaucoma drops are added to control the pressure.
Close Monitoring
Regular pressure checks are recommended for anyone on long-term steroid therapy of any kind, especially those with a personal or family history of glaucoma.
Surgery in Refractory Cases
If the steroid must be continued indefinitely and pressure remains uncontrolled on drops, laser or surgical treatment may be considered, following the same options used in open-angle glaucoma.
How This Differs From Other Glaucomas
Steroid-induced glaucoma is one of the few glaucomas that can be fully reversible if caught early, since removing the trigger (the steroid) often normalizes pressure — a treatment option that simply doesn't exist for most other glaucomas on this page.
Management also requires coordinating with whichever doctor prescribed the steroid (dermatology, allergy, rheumatology, pulmonology, or others), since the steroid may be treating something serious that can't simply be stopped, which is a layer of cross-specialty coordination not typically needed in primary open-angle glaucoma.
Frequently Asked Questions
Which steroids can cause this?
Any route of steroid exposure has been reported to raise eye pressure in susceptible individuals, including eye drops (the most potent and fastest-acting), oral steroids, inhaled steroids for asthma, nasal sprays for allergies, steroid skin creams, and steroid joint or eye injections.
Am I a 'steroid responder'?
Roughly 30–40% of the general population shows some rise in eye pressure with prolonged steroid exposure, and about 5% are 'high responders' with a marked rise. A family history of glaucoma increases the likelihood of being a responder.
Is this permanent?
Often not, if caught early: pressure frequently returns to normal after the steroid is stopped or switched to a lower-impact option. However, if elevated pressure has been present long enough to damage the optic nerve, that damage is permanent even after the steroid is discontinued.
Can I just stop my steroid on my own?
No — please don't stop a prescribed steroid without talking to the prescribing doctor first, especially oral or long-term steroids, which can have serious withdrawal effects. We coordinate with your other doctors to find the safest path forward.
See a glaucoma specialist. Dr. Robert Gunzenhauser is Harvard-educated and UCLA fellowship-trained in glaucoma, providing expert diagnosis and treatment for Steroid-Induced Glaucoma at Inland Glaucoma Center in Upland, CA.