steroid-induced glaucoma - borderline

Steroid-Induced Glaucoma - Borderline

Steroid-induced glaucoma, also known as corticosteroid-induced glaucoma, is a type of secondary open-angle glaucoma that occurs due to the use of corticosteroids. This condition is characterized by an increase in intraocular pressure (IOP) and can lead to optic nerve atrophy and progressive vision loss.

Symptoms and Risk Factors

The symptoms of steroid-induced glaucoma are similar to those of primary open-angle glaucoma, making it challenging to diagnose. However, certain risk factors can indicate a higher likelihood of developing this condition:

• Age: Children and older adults are more susceptible to steroid-induced IOP elevation or glaucoma.
• Steroid response: Individuals who respond to corticosteroids with an increase in IOP are at a higher risk of developing steroid-induced glaucoma.
• High myopia: People with high myopia (nearsightedness) may be more prone to steroid-induced glaucoma.
• Angle-recession glaucoma: This type of glaucoma can also increase the risk of developing steroid-induced glaucoma.

Mechanism and Pathogenesis

The exact mechanism behind steroid-induced glaucoma is unknown, but it is believed that corticosteroids cause physical and mechanical changes in the trabecular meshwork (TM), leading to an increase in aqueous outflow resistance. This results in elevated IOP, which can lead to optic nerve atrophy and progressive vision loss if left untreated.

Prevalence and Treatment

Steroid-induced glaucoma is a relatively rare condition, but its prevalence is increasing due to the widespread use of corticosteroids. There are currently no human or mouse genes associated with this disease in the MGI database. Treatment options for steroid-induced glaucoma include reducing or discontinuing corticosteroid use and managing IOP through medication or surgery.

References

• [1] Steroids were first used in the US in 1912, and steroid-induced glaucoma has been recognized for over 60 years after a report in 1950 of a rise in eye pressure after systemic adrenocorticotrophic hormone (ACTH) [2].
• [3] Corticosteroid-induced glaucoma has symptoms similar to primary open-angle glaucoma, making it challenging to diagnose [4].
• [5] The exact mechanism behind steroid-induced glaucoma is unknown, but corticosteroids cause physical and mechanical changes in the trabecular meshwork (TM), leading to an increase in aqueous outflow resistance [6].

Note: The references provided are based on the information available within the search results.

Based on the context provided, it appears that you are looking for information on the signs and symptoms of steroid-induced glaucoma, specifically in cases where the condition is considered "borderline".

What is Steroid-Induced Glaucoma?

Steroid-induced glaucoma is a rare but serious side effect of corticosteroid use. It occurs when prolonged use of steroids leads to increased intraocular pressure (IOP), which can damage the optic nerve and potentially cause vision loss.

Signs and Symptoms of Steroid-Induced Glaucoma

In cases where steroid-induced glaucoma is considered borderline, the signs and symptoms may be less severe or less obvious than in more advanced cases. However, it's essential to recognize these warning signs to prevent further damage:

• Increased IOP: The most critical sign of steroid-induced glaucoma is a sustained increase in IOP, which can range from mild to severe.
• Pain and Redness: Patients may experience eye pain or tenderness, especially when moving the affected eye. The eye may also appear red or inflamed.
• Vision Changes: Borderline cases may exhibit subtle changes in vision, such as:
  • Blurred vision
  • Double vision (diplopia)
  • Sensitivity to light
  • Difficulty seeing colors or contrast
• Other Symptoms: Some patients may experience additional symptoms, including:
  • Headaches
  • Eye fatigue
  • Dryness or irritation of the eyes

What to Do If You Suspect Steroid-Induced Glaucoma

If you're experiencing any of these symptoms and have been using corticosteroids, it's crucial to consult an eye care professional immediately. They will perform a comprehensive examination, including tonometry (IOP measurement), to determine the severity of the condition.

References:

• [1] American Academy of Ophthalmology. Steroid-Induced Glaucoma. Retrieved from https://www.aao.org/eye-care/glaucoma/st... (Note: This link is provided for reference purposes only and should not be accessed directly.)
• [2] MedlinePlus. Steroid-Induced Glaucoma. Retrieved from https://medlineplus.gov/ency/article/001601.htm (Note: This link is provided for reference purposes only and should not be accessed directly.)

Please consult a medical professional for personalized advice on steroid-induced glaucoma symptoms and treatment.

Steroid-induced glaucoma can be challenging to diagnose, especially when patients present with borderline intraocular pressure (IOP) values. In such cases, careful evaluation and monitoring are crucial to determine the presence or absence of glaucoma.

Appropriate testing for a glaucoma suspect

According to [5], appropriate baseline testing for a glaucoma suspect includes:

• Gonioscopy: This is a critical test that allows ophthalmologists to examine the angle between the iris and cornea, which can provide clues about the cause of angle closure. As mentioned in [6], careful gonioscopy often shows subtle changes that can be detected by experienced eye care professionals.
• Pachymetry: This measures the thickness of the cornea, which is essential for assessing IOP.
• Tonometry: This measures IOP directly and is a crucial test for diagnosing glaucoma.
• Perimetry: This assesses the field of vision and can help identify any defects or abnormalities.

Additional tests

If a diagnosis of glaucoma is not confirmed, additional testing may be necessary. These include:

• OCT (Optical Coherence Tomography): This imaging test can provide detailed information about the optic nerve and retina.
• Visual fields: This assesses the field of vision and can help identify any defects or abnormalities.

Importance of baseline testing

Baseline testing is essential for diagnosing steroid-induced glaucoma, especially when patients present with borderline IOP values. As mentioned in [9], appropriate baseline testing includes IOP, optic nerve exam, OCT, visual fields, and angle assessment.

Success rates after surgery

For patients with steroid-induced glaucoma who underwent trabeculectomy, the success rate was reported to be 88.1% at the three-year follow-up [10]. However, it's essential to note that surgical failure can occur in some cases, with a reported rate of 11.9% to 16.7% [10].

References

• [5] SJ Gedde · 2021 · Cited by 40 — Appropriate testing to evaluate and monitor patients diagnosed as a glaucoma suspect includes gonioscopy, pachymetry, tonometry, perimetry, ...
• [6] Careful gonioscopy often shows subtle changes that your ophthalmologist can detect to give clues as to the cause of the angle closure, a skill all GAT Doctors ...
• [9] Appropriate baseline testing for a glaucoma suspect includes IOP, optic nerve exam, OCT, visual fields, and angle assessment.
• [10] The success rate was reported to be 88.1% at the three-year follow-up.

Treatment Options for Steroid-Induced Glaucoma

Steroid-induced glaucoma, also known as medication-induced glaucoma, is a condition where the use of corticosteroids leads to an increase in intraocular pressure (IOP), potentially causing damage to the optic nerve and vision loss. In cases where steroid-induced glaucoma is borderline or mild, treatment options may focus on managing the condition without immediately resorting to surgery.

Medical Therapies

Most patients with mild to moderate steroid response can be managed with medical therapies [12]. These may include:

• Mast cell stabilizers: Initially prescribed for patients who are steroid responders [9].
• Topical carbonic anhydrase inhibitors (CAIs): Such as dorzolamide (Trusopt), which is commonly used in managing glaucoma in dogs and cats [6].
• Other topical medications: May be used to reduce IOP and manage the condition.

Surgical Options

However, many cases of steroid-induced glaucoma may require surgery. Surgical options include:

• Goniotomy: A procedure that involves making a small incision in the trabecular meshwork to improve drainage and reduce IOP [10].
• Canaloplasty: Another surgical option that aims to restore the natural outflow of fluid from the eye, thereby reducing IOP [11].

Importance of Early Detection

Early detection and treatment are crucial in managing steroid-induced glaucoma. If left untreated or inadequately managed, the condition can progress to more severe stages, potentially leading to vision loss.

References:

[6] Dozolamide (Trusopt) is a topical carbonic anhydrase inhibitor used most frequently in managing glaucoma in dogs and cats. [9] Protocol of treatment in flow chart in cases of steroid-induced glaucoma. Steroid responder patients were prescribed initially mast cell stabilisers and... [10] Goniotomy and canaloplasty have also been shown to be effective treatments for steroid-induced glaucoma. [11] Goniotomy and canaloplasty have also been shown to be effective treatments for steroid-induced glaucoma. [12] Most patients with mild to moderate steroid response can be managed with medical therapies.

Differential Diagnosis of Steroid-Induced Glaucoma

Steroid-induced glaucoma can be challenging to diagnose, as it may present with similar symptoms to other types of glaucoma. A differential diagnosis is essential to rule out other conditions and confirm the presence of steroid-induced glaucoma.

Possible Differential Diagnoses:

• Primary Open Angle Glaucoma (POAG): This is a common type of glaucoma that can be mistaken for steroid-induced glaucoma. POAG is characterized by increased intraocular pressure (IOP) due to impaired outflow of aqueous humor.
• Normal Tension Glaucoma: This type of glaucoma is also known as low-tension glaucoma, and it presents with normal IOP but optic nerve damage.
• Juvenile Open Angle Glaucoma: This is a rare type of glaucoma that affects children and young adults. It can be mistaken for steroid-induced glaucoma due to its similar presentation.
• Uveitic Glaucoma: This type of glaucoma occurs in patients with uveitis, an inflammatory condition affecting the uvea (the middle layer of the eye).
• Angle-Recession Glaucoma: This is a rare type of glaucoma caused by a recession of the anterior chamber angle.
• Pigmentary Glaucoma: This type of glaucoma occurs when pigment from the iris accumulates in the trabecular meshwork, leading to increased IOP.

Key Factors to Consider:

When diagnosing steroid-induced glaucoma, it is essential to consider the following factors:

• History of corticosteroid use: A history of corticosteroid use is a crucial factor in diagnosing steroid-induced glaucoma.
• Age and myopia: Children and young adults are at higher risk for developing steroid-induced glaucoma. High myopia can also increase the risk.
• Type 1 diabetes mellitus: Patients with type 1 diabetes mellitus may be more susceptible to steroid-induced glaucoma.
• Connective tissue disease: Certain connective tissue diseases, such as rheumatoid arthritis, can increase the risk of developing steroid-induced glaucoma.

Conclusion:

A differential diagnosis is essential when suspecting steroid-induced glaucoma. By considering the possible differential diagnoses and key factors mentioned above, healthcare professionals can accurately diagnose and manage this condition.