A Cross-Sectional Study on the Prevalence and Risk Factors of Steroid-Induced Glaucoma at a Tertiary Eye Care Hospital

Background: Steroid-induced glaucoma (SIG) is a well-recognized complication of corticosteroid therapy, leading to elevated intraocular pressure (IOP) and potential irreversible optic nerve damage. Despite widespread steroid use for ocular conditions, inadequate monitoring, especially with over-the-counter (OTC) preparations, increases the risk of SIG. This study aimed to determine the prevalence and identify the risk factors associated with SIG in a tertiary eye care setting. Methods: This cross-sectional study was conducted at the Glaucoma Department of Poona Blind Men's Association (PBMA)'s H.V. Desai Eye Hospital in Pune, India, over 20 months. A total of 190 patients (380 eyes) with SIG were identified from 4609 glaucoma cases. Inclusion criteria involved patients aged >10 years with a history of ocular steroid use and newly diagnosed SIG. Examinations included visual acuity, IOP measurement, gonioscopy, optic nerve evaluation, perimetry, and imaging. Patients were treated with anti-glaucoma medications (AGMs) or surgery when indicated. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, New York, United States). Results: SIG prevalence was 4.1%. Most patients (59%) were above 45 years; 53.2% were male. While 60.5% had no known risk factors, 13.1% had diabetes, 12.1% were under 20 years, and others had high myopia or rheumatoid arthritis. Topical dexamethasone was the most used steroid (50%), with most using steroids for 1-3 months. IOP significantly reduced from a mean of 26.8 mmHg at baseline to 14.1 mmHg at six months (p<0.001). AGM sufficed in 93.6% of eyes, while 6.4% required trabeculectomy. Visual acuity and optic disc status remained largely stable. Conclusion: SIG is a preventable cause of vision loss. Early detection, rational steroid use, regular IOP monitoring, and public education are essential to mitigate this iatrogenic burden.