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👁 What is Steroid-Induced Glaucoma (SIG)?

Steroid-induced glaucoma (SIG) is a form of secondary glaucoma
caused by elevated intraocular pressure (IOP) after using steroids,
whether topical, periocular, systemic, or injected.


🔬 Mechanism of SIG

  • Steroids alter trabecular meshwork structure
  • ECM (extracellular matrix) deposition
  • Phagocytic activity → waste builds up
  • Outflow resistance increasesIOP rises

 

 

 

📊 IOP Response Rate (Armaly Study)

ReactionIncidence
Minimal (<5 mmHg) 66%
Moderate (6–15 mmHg) 30%
High (>15 mmHg) 5%

Roughly 1 in 3 individuals may be a steroid responder


👥 High-Risk Steroid Responders

  • Glaucoma patients / family history
  • Diabetes, hypertension
  • High myopia, connective tissue diseases
  • Children under 6, elderly

💧 Risk by Route of Administration

MethodRisk Level
Periocular injection Very high
Topical drops/ointments Common and significant
Systemic / skin creams Lower risk

 

 


💊 Drug Risk Classification

CategoryExamples
High-risk Dexamethasone, Prednisolone
Low-risk Rimexolone, Loteprednol, Fluorometholone
  • Fluorometholone is the safest and most widely used
  • Combination formulations (e.g., with antibiotics) need monitoring

✅ Summary

  • Steroids can cause IOP elevation and glaucoma
  • Regular IOP monitoring is critical, especially in high-risk groups
  • Dose reduction or switching to low-risk steroids may be needed
  • Refractory cases may require laser or surgical intervention
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