Steroid-Induced Glaucoma

Excerpt

Steroids are one of the most commonly prescribed drugs, used mainly to treat various autoimmune and inflammatory conditions. Although it has numerous benefits, steroid usage can cause many adverse effects on the eye, the most important being steroid-induced glaucoma and cataract. Steroid-induced iatrogenic glaucoma was described for the first time in the 1950s, with the observation of glaucoma following the use of systemic adrenocorticotropic hormones and topical or systemic steroids.

Several factors seem to play a crucial role in causing elevated intraocular pressure (IOP), mostly due to the increase of the resistance in the outflow mechanisms of the trabecular meshwork (TM). It has been shown that glucocorticoids (GC) can alter the microstructure by inducing cross-links in the network of the actin fiber. There also appears to be an increase in collagen and fibronectin deposits in the juxtacanalicular region's extracellular matrix. Corticosteroids have also been shown to influence the turnover of substances and enzymes (i.e., stromelysin, metalloproteinases, tissue plasminogen activator, etc.) in the TM, which give rise to increased outflow resistance in this important structure that regulates IOP levels.