Inhaled Corticosteroids and Glaucoma Risk in Infants
Low-to-medium dose inhaled corticosteroid therapy has no significant effects on the incidence of glaucoma in children, including infants. 1
Evidence from Guidelines
The most authoritative evidence comes from comprehensive guideline reviews published in the Journal of Allergy and Clinical Immunology, which specifically addressed this concern:
Children using inhaled corticosteroids at recommended doses show no relationship between glaucoma or increased intraocular pressure and inhaled corticosteroid use. 1
The available data demonstrate no significant effects on glaucoma incidence with low-to-medium dose inhaled corticosteroid therapy in the pediatric population (SRE-Evidence A, C). 1
Limited ocular pressure measurements from clinical trials consistently showed no association between inhaled corticosteroids and elevated intraocular pressure in children. 1
Supporting Research Evidence
Recent high-quality research actually suggests a protective effect rather than harm:
A large cohort study of 5,380 children with asthma found that those using inhaled corticosteroids had a 48% decreased risk of developing glaucoma compared to non-users (adjusted HR 0.52,95% CI 0.28-0.96). 2
A prospective 2-year study of 95 children on inhaled steroids found zero cases of ocular hypertension or glaucoma, with all intraocular pressures remaining in the normal range (11-20 mm Hg). 3
Important Clinical Caveats
Age-Specific Considerations
The evidence for lack of glaucoma risk is stronger in children than adults, where studies show minimal clinically significant effects at recommended doses. 4
Infants and young children appear to have even lower risk than older populations, as baseline glaucoma incidence in this age group is essentially zero. 1
Risk Factors That Do Matter
Family history of glaucoma is the critical risk factor to assess. In adults with a positive family history, inhaled corticosteroids showed increased glaucoma risk (OR 2.6), but this association was not found in those without family history. 5
Cataracts (not glaucoma) are positively associated with glaucoma development in asthmatic children (adjusted HR 8.22). 2
Dose and Route Considerations
The safety data applies to low-to-medium doses of inhaled corticosteroids—not high cumulative lifetime doses exceeding 2000 mg. 1, 6
Topical ocular corticosteroids carry substantially higher glaucoma risk than inhaled preparations and should be monitored differently. 7
Clinical Recommendations
For infants requiring inhaled corticosteroids:
Proceed with treatment without concern for glaucoma risk at recommended doses. 1
Document family history of glaucoma, though even this risk factor is primarily relevant in adult populations. 5
Monitor growth and other systemic effects rather than focusing on glaucoma screening. 8
Routine ophthalmologic screening for glaucoma is not indicated in infants on inhaled corticosteroids without other risk factors. 3
If high doses are necessary, consider adjunctive therapy to minimize total corticosteroid exposure. 1