Doctors Warn: Steroid Misuse is a Major Trigger for Secondary Glaucoma

Ophthalmologists in the city have raised concern over widespread and often unsupervised use of steroids, warning that it is emerging as a major trigger for secondary glaucoma — a sight-threatening condition that can lead to irreversible blindness. January is observed as Glaucoma Awareness Month. Intraocular pressure Steroids prescribed for allergies, skin disorders and respiratory illnesses, and sold over the counter as eye drops, can significantly raise intraocular pressure when used for prolonged periods. Patients often remain unaware that the optic nerve is being damaged, doctors said. India is estimated to have 12 to 13 million people living with glaucoma, accounting for nearly one-sixth of the global burden. Globally, around 75 to 80 million people are affected and the number is projected to cross 110 million by 2040. Despite being the leading cause of irreversible blindness worldwide, glaucoma remains underdiagnosed in India. Asymptomatic Mallesh H., Resident Medical Officer of the State-run Minto Ophthalmic Hospital, said nearly 90% of glaucoma cases remain undetected as the disease progresses silently. “Unlike cataract, glaucoma is asymptomatic without warning signs. But early diagnosis and treatment can help patients retain useful vision lifelong,” he said, recommending a baseline eye screening at 40 years. Doctors have reported a steady increase in diagnosed cases over the past two to three years owing to an ageing population, rising diabetes and myopia, and wider access to diagnostics. However, a growing proportion of cases are linked to prolonged or unsupervised steroid use - an avoidable risk factor if recognised early. “We are seeing more steroid-induced glaucoma among patients who use steroid medications or eye drops without supervision,” said Sandhya E.S., Consultant Ophthalmologist at Dr. Agarwals Eye Hospital. “Patients often feel symptom-free initially, while eye pressure rises silently causing permanent damage,” she said. Steroid responders Rohit Shetty, chairman, Narayana Nethralaya, said steroid preparations may provide quick relief but can elevate eye pressure in nearly 25–30% of users, termed “steroid responders”. Chronic use of topical skin creams or systemic steroids for asthma, sinusitis or skin disease can precipitate the response. His hospital sees six to seven such cases every month. Adding another dimension, Jayashree K. Bhat, consultant – Ophthalmology at Aster RV Hospital, described steroids as a “double-edged sword”. “Steroids can be lifesaving and sometimes there is no alternative. But while physicians routinely check blood pressure and sugar before giving steroids to diabetics or hypertensives, the possibility of glaucoma often gets overlooked,” she said. There is no established protocol requiring ophthalmic clearance before initiating steroids, she pointed out. Screening is key Long-term steroids for chronic lung disease, asthma, chemotherapy-related inflammation, or through inhalers, tablets or intravenous routes can raise eye pressure in susceptible individuals. “Not everybody is at risk. Some patients are steroid responders and some have anatomical or familial predisposition. Screening is the only way to identify them,” she said. Pointing out that unsupervised use of steroid eye drops for allergies and minor redness, and use of products that contain dexamethasone remains common, she said that cases are also triggered by medications from alternative systems that patients do not disclose. Under supervision All the doctors stressed that steroids should be used only under medical supervision and stopped once the indication resolves, warning that indiscriminate or prolonged use can lead to glaucoma and cataract. They advised individuals with diabetes, hypertension, thyroid disorders, high myopia, long-term steroid exposure or a history of eye injury to undergo periodic screening as part of glaucoma prevention.