Do oral corticosteroids (oral steroids) increase intraocular pressure (IOP)?

From the Guidelines

Yes, oral steroids can raise intraocular pressure (IOP). According to the most recent evidence, corticosteroids like prednisone, dexamethasone, and methylprednisolone are known to cause steroid-induced ocular hypertension in some individuals, particularly with prolonged use (typically after 2-4 weeks of therapy) or at higher doses 1. The risk varies among patients, with approximately 30-40% of the general population experiencing moderate IOP elevation and 5-6% developing significant pressure increases. This effect occurs because steroids increase resistance to aqueous humor outflow by altering the structure of the trabecular meshwork, the tissue responsible for draining fluid from the eye. Certain individuals are more susceptible, including those with primary open-angle glaucoma, family history of glaucoma, high myopia, diabetes, or connective tissue diseases. The IOP elevation is usually reversible upon discontinuation of steroids, but in some cases, the pressure increase can persist and require treatment with IOP-lowering medications or even surgery. Patients taking oral steroids should have regular eye examinations to monitor for pressure changes, especially if treatment extends beyond two weeks or if they have risk factors for glaucoma.

Key Points to Consider

• Oral steroids can increase IOP, particularly with prolonged use or at higher doses
• Certain individuals are more susceptible to steroid-induced ocular hypertension, including those with primary open-angle glaucoma, family history of glaucoma, high myopia, diabetes, or connective tissue diseases
• Regular eye examinations are necessary to monitor for pressure changes in patients taking oral steroids
• The IOP elevation is usually reversible upon discontinuation of steroids, but in some cases, the pressure increase can persist and require treatment with IOP-lowering medications or even surgery

Recommendations for Clinical Practice

• Use oral steroids with caution, particularly in patients with risk factors for glaucoma
• Monitor patients taking oral steroids regularly for pressure changes
• Consider alternative treatments for patients with risk factors for glaucoma or those who have experienced steroid-induced ocular hypertension in the past
• Educate patients about the potential risks of oral steroids and the importance of regular eye examinations.

From the FDA Drug Label

Intraocular pressure may become elevated in some individuals If steroid therapy is continued for more than 6 weeks, intraocular pressure should be monitored.

Yes, oral steroids, such as prednisone, may raise intraocular pressure (IOP) in some individuals 2.

• Patients on long-term steroid therapy (more than 6 weeks) should have their IOP monitored.

From the Research

Oral Steroids and Intraocular Pressure

• Oral steroids can raise intraocular pressure (IOP) in some individuals, as evidenced by studies on steroid-induced ocular hypertension and glaucoma 3, 4, 5.
• The mechanism of elevated IOP is thought to be due to increased aqueous outflow resistance caused by structural changes in the trabecular meshwork 4, 5.
• A study on children with autoimmune hepatitis found that long-term oral steroids can cause raised IOP in approximately 61% of patients, with the risk being higher in those with more severe liver disease 6.
• The study also found that raised IOP returned to normal with antiglaucoma medication and prednisone tapering in most patients, highlighting the importance of monitoring IOP in patients on oral steroids 6.

Risk Factors and Treatment

• Risk factors for oral steroid-induced ocular hypertension include individual responsiveness, potency of the steroid, route of administration, and duration of treatment 5.
• Treatment options for steroid-induced ocular hypertension and glaucoma are similar to those for primary open-angle glaucoma, and may include antiglaucoma medication and tapering of the steroid dose 3, 4, 6.
• It is essential to monitor IOP regularly in patients on oral steroids, especially in those with a history of glaucoma or ocular hypertension, to prevent irreversible vision loss 6.