Once steroid-induced OHT or glaucoma is diagnosed, the inciting drug should be stopped or the dosage reduced where possible. Alternatively, a different steroid formulation may be prescribed. Where steroid-induced OHT or glaucoma is irreversible, the stepwise management approach parallels that of primary-open angle glaucoma. Medical antiglaucomatous therapy comprises topical beta-blockers, alpha-agonists, carbonic anhydrase inhibitors (both topical and systemic), and prostaglandin analogues. The latter, however, may not be useful in cases of concomitant uveitic glaucoma or cystoid macular oedema. Selective laser trabeculoplasty (SLT) may potentially work as a temporizing measure in patients with steroid-induced OHT [ 25 ]. Whilst trabeculectomy and tube shunts are the preferred surgical option in adults with corticosteroid-induced OHT or glaucoma, goniotomy should be considered for initial surgical treatment in children with persistent steroid-induced glaucoma [ 26 ].
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.