| Steroids |
Question: What defines a steroid responder in glaucoma?
Answer:
A steroid responder is a patient who in response to steroid use (usually topically in the eye, but also orally and even topically on the skin or in the nose) has a rise in IOP. The rise can be anywhere from a few units to more than 30 mm Hg above normal.
Dr. Rick Wilson
October 17, 2007
|
Question: How quickly will IOP drop after steroids are discontinued?
Answer:
It is said that the longer one is on the steroids, the longer it will take for the IOP to return to normal.
Another factor is that those who are subject to IOP rises on steroids are genetically predisposed to developing glaucoma. Sometimes when the IOP goes up, it does not come all the way back down.
Dr. Rick Wilson
October 17, 2007
|
Question: Are sprays like nasonex and flonase steroids? Are they likely to cause a steroid response?
Answer:
Yes, nasonex and flonase are steroids, usually a weak solution of very strong steroids.
Patients taking nasally administered steroids for allergies are prone to IOP rise because the absorption through the nasal mucosa is rapid and nearly complete. You are less likely to absorb enough steroid through the skin (if it doesn't get into the eye) to cause an IOP rise, but it can happen, especially in patients using steroids over a large area of skin, or close to the eye.
Dr. Rick Wilson
October 17, 2007
|
Question: Does having psoriasis have any effect on glaucoma?
Answer:
No, unless steroids are used either orally or topically at a dosage that causes a patient who is sensitive to them to have a rise in IOP. Rarely, there may be an associated inflammation in the eye that could also cause a rise in pressure.
Dr. Rick Wilson
October 17, 2007
|
Question: Why is Pred Forte used in eye surgery? What are the effects of its long-term use?
Answer:
Pred Forte (prednisolone acetate) is a steroid. It's used before and after surgery to reduce inflammation and reduce scar tissue that causes glaucoma surgery to fail. Long-term use can cause cataract or even elevate the pressure. It can also increase the risk of infection. That said, we often use it for a long time because it keeps inflammation down. Eyes that have had many surgeries can stay inflamed for a long time and can have bouts of rebound inflammation.
Dr. Michael James Pro
November 15, 2006
|
Question: Can the Pred Forte used after a trabeculectomy elevate the pressure in both eyes?
Answer:
Good question. I suppose that it would be possible for the Pred Forte to raise IOP in the fellow eye, but in my experience that doesn't happen, probably because there's neither enough time nor a strong enough dose for there to be a problem.
Dr. Jeff Henderer
May 31, 2006
|
Question: Is there anything to contraindicate the use of nonsteroidal anti-inflammatory drugs in a glaucoma patient generally, or in pigmentary glaucoma specifically?
Answer:
There should be no reason not to take nonsteroidals.
Dr. Rick Wilson
April 06, 2005
|
Question: Are there medications that can cause glaucoma?
Answer:
Oral or topical steroids can cause glaucoma. I am not familiar with any others that do.
Dr. Rick Wilson
March 29, 2006
|
Question: How quickly does IOP rise when oral or topical steroids are used?
Answer:
For steroids taken orally, the IOP rise can come within a week or two. For steroids administered topically, it usually takes 3 to 6 weeks, but often may not show up for months.
Dr. Rick Wilson
March 29, 2006
|
Question: Once you stop using a steroid, does your IOP return to normal? What about the risk of glaucoma?
Answer:
Usually the IOP drops after a period of time that is said to be similar in length to the time spent on the steroids. However, developing glaucoma while on steroids is a genetic marker for being prone to develop glaucoma even without steroids.
Dr. Rick Wilson
March 29, 2006
|
Question: Should you continue taking steroids if you develop glaucoma?
Answer:
The glaucoma can be treated with one modality or another. It is a value judgement concerning the disease you are treating with steroids as to whether there is another possible treatment that will be effective.
Dr. Rick Wilson
March 29, 2006
|
Question: What is the mechanism behind steroid-induced glaucoma, and is it treated the same way as primary open-angle glaucoma?
Answer:
We don't know for sure, but it is possible that steroids inhibit the normal cleansing function of the cells lining the beams making up the drain in the eye. Therefore, more debris builds up. Steroid-induced glaucoma is treated like primary open-angle glaucoma, with the warning that steroid drops need to be stopped. If an anti-inflammatory drop is needed, move to cyclosporin or a nonsteroidal drop.
Dr. Rick Wilson
February 16, 2005 |
