Published 1 August 2008, doi:10.1136/bmj.a670
Cite this as: BMJ 2008;337:a670

Practice

Lesson of the Week

Advanced glaucomatous visual loss and oral steroids

¹ Department of Ophthalmology, Queen Margaret Hospital, Dunfermline KY12 0SU, ² Leven Health Centre, Leven KY8 4ET, ³ Clinical Neurosciences, Department of Neurology, Ninewells Hospital and Medical School, Dundee DD1 9SY

Blindness induced by glaucoma is a serious but preventable side effect of long term, high dose steroids

The first 150 words of the full text of this article appear below.

Ocular side effects of steroid eye drops include cataract, glaucoma, and corneal infections.^{1 2 3} These side effects are well known to general practitioners and ophthalmologists, who are the main prescribers of steroid eye drops.^{4 5} Oral steroids, however, are prescribed by a wide range of doctors in primary and secondary care.⁶ The potential complication of systemic, steroid induced glaucoma is less well known. This leads to irrevocable visual loss. The patient may be asymptomatic until central vision is affected.⁷ We report such a case.

A 63 year old man attended his usual optometrist in April 2005 complaining of gradual difficulty in focusing with his right eye over two months. The optometrist found raised intraocular pressures, cupping of the optic disc, and visual field loss and referred him urgently to hospital. At the hospital consultation his Snellen’s visual acuity was 6/12 right with an afferent pupillary defect and 6/6 left. Colour vision testing . . . [Full text of this article]

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