Steroid induced glaucoma after lasik

During conventional pharmacologic dose corticosteroid therapy, ACTH production is inhibited with subsequent suppression of cortisol production by the adrenal cortex. Recovery time for normal HPA activity is variable depending upon the dose and duration of treatment. During this time the patient is vulnerable to any stressful situation. Although it has been shown that there is considerably less adrenal suppression following a single morning dose of prednisolone (10 mg) as opposed to a quarter of that dose administered every six hours, there is evidence that some suppressive effect on adrenal activity may be carried over into the following day when pharmacologic doses are used. Further, it has been shown that a single dose of certain corticosteroids will produce adrenal cortical suppression for two or more days. Other corticoids, including methylprednisolone, hydrocortisone, prednisone, and prednisolone, are considered to be short acting (producing adrenal cortical suppression for 1¼ to 1½ days following a single dose) and thus are recommended for alternate day therapy.

* Mydriatics and cycloplegics. While certainly not a systemic medication, it is worth noting that topical tropicamide may cause increased IOP via mechanisms other than angle closure. After examining IOP fluctuations in children given mydriatics, researchers found an average increase of 2mm Hg; however, a potential increase or decrease of 8mm Hg was documented in many patients with open angles. 27 The investigators concluded that some alteration in aqueous dynamics occurred upon dilation and, because of the variable effect on IOP (even without the presence of anterior segment complications), all patients who use mydriatics require observation. 27

Nadia: Sorry for your troubles. You have just described the course of a steroid responder. Your pressure was fine for the first few weeks, but after being on a corticosteroid for several weeks your pressure began to rise. If inflammation is well controlled, most surgeons stop the steroid or switch to a weaker steroid if the pressure is hard to control. If you are on a non-steroidal anti inflammatory (NSAID), it makes it easer to get off of the steroid since these drops will still help control inflammation when the steroid is stopped. Sometimes it takes several months for the steroid pressure elevation to resolve. During that time, maximum medical management is attempted. If a patient already has weakened nerves from glaucoma, sometimes a glaucoma surgery must be used to lower the pressure and protect vision.
God Bless,
Gary Foster

An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (., myasthenia gravis ), or in patients receiving concomitant therapy with neuromuscular blocking drugs (., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis . Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.

Steroid induced glaucoma after lasik

steroid induced glaucoma after lasik

An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (., myasthenia gravis ), or in patients receiving concomitant therapy with neuromuscular blocking drugs (., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis . Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.

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