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Steroid-induced Glaucoma

Disease Details

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Description: Steroid-induced glaucoma is an increase in intraocular pressure leading to optic nerve damage and vision loss, caused by the prolonged use of corticosteroid medications.
Type: Steroid-induced glaucoma is not classified as a genetic disease; hence, it does not have a type of genetic transmission. Instead, it is a secondary form of open-angle glaucoma that occurs in response to the use of corticosteroids.
Signs And Symptoms: Signs and symptoms of steroid-induced glaucoma include:

- Elevated intraocular pressure (IOP)
- Vision loss or blurred vision
- Eye pain or discomfort
- Haloes around lights
- Redness in the eye
- Nausea or vomiting (in severe cases)

Steroid-induced glaucoma can occur with the use of corticosteroid medications, and symptoms may develop gradually as the pressure in the eye increases. Regular monitoring by an eye care professional is important for individuals on long-term steroid therapy.
Prognosis: Steroid-induced glaucoma is a form of secondary open-angle glaucoma that results from the use of corticosteroids. The prognosis depends on several factors including the duration and dosage of steroid use, as well as how promptly the condition is diagnosed and treated. If detected early and managed appropriately, the prognosis can be favorable with a good chance of maintaining vision. This typically involves discontinuing or reducing the steroid use and starting anti-glaucoma medications or procedures to lower intraocular pressure. Delayed diagnosis or treatment can result in more significant optic nerve damage and potential loss of vision. Regular monitoring and follow-up with an eye care professional are crucial.
Onset: Steroid-induced glaucoma typically has an insidious onset. The increase in intraocular pressure (IOP) can occur within a few weeks to several months after initiating corticosteroid therapy, whether the steroids are administered topically, orally, or via other routes. The risk and timing of onset can vary depending on the individual’s susceptibility, the potency of the steroid, and the duration of use. Regular monitoring of IOP is essential in patients receiving corticosteroids to detect and manage this condition early.
Prevalence: Prevalence data for steroid-induced glaucoma is not well-defined in population-wide studies. However, among individuals who use corticosteroids, approximately 18-36% may develop increased intraocular pressure, which can lead to glaucoma. The risk varies based on factors such as the type of steroid, dosage, duration of use, and individual susceptibility.
Epidemiology: Steroid-induced glaucoma is a form of secondary open-angle glaucoma that results from the use of corticosteroids. Its epidemiology includes the following points:

1. **Prevalence**: The exact prevalence is not well-defined but it is considered a significant iatrogenic cause of glaucoma. It tends to occur more commonly in individuals who are "steroid responders."
2. **Risk Factors**: Individuals with a family history of glaucoma, pre-existing open-angle glaucoma, myopia (nearsightedness), or connective tissue diseases (such as rheumatoid arthritis) are at a higher risk.
3. **Demographic Variations**: Adults are more commonly affected than children, although children can also be susceptible, especially with prolonged corticosteroid usage.
4. **Incidence and Usage**: The risk increases with the potency and duration of steroid use. Both systemic (oral, intravenous) and topical (ophthalmic drops, ointments) steroids can cause elevated intraocular pressure, leading to glaucoma.
5. **Genetic Predisposition**: Some individuals have a genetic predisposition to respond to steroids with increased intraocular pressure due to specific variations in the MYOC gene.

Efforts to prevent and manage steroid-induced glaucoma include careful monitoring of intraocular pressure during steroid therapy, especially in high-risk populations. Early detection and timely management are crucial for preventing irreversible visual field loss.
Intractability: Steroid-induced glaucoma can often be managed and controlled, though it may not be entirely curable. Management typically involves discontinuing or reducing steroid use, if possible, and using medications to lower intraocular pressure. In some cases, surgical intervention might be necessary. While the condition can be challenging, it is not generally considered completely intractable if properly treated and monitored.
Disease Severity: Steroid-induced glaucoma is a secondary form of open-angle glaucoma resulting from prolonged use of steroid medications. The severity of the disease can vary depending on how quickly it is detected and managed. Without appropriate intervention, it can lead to significant visual impairment or blindness due to increased intraocular pressure damaging the optic nerve. Therefore, regular monitoring and prompt treatment are crucial to control the symptoms and prevent severe outcomes.
Healthcare Professionals: Disease Ontology ID - DOID:9946
Pathophysiology: Steroid-induced glaucoma is a condition characterized by an increase in intraocular pressure (IOP) due to the use of corticosteroids. The pathophysiology involves corticosteroids affecting the trabecular meshwork in the eye, which is responsible for draining aqueous humor. Steroids increase the deposition of extracellular matrix materials and glycosaminoglycans in the trabecular meshwork, reducing its permeability and impairing aqueous outflow. This leads to increased IOP, which can damage the optic nerve and result in glaucoma if not managed appropriately.
Carrier Status: Steroid-induced glaucoma is not associated with a carrier status as it is not a genetic disorder. It is a condition that can occur in response to prolonged use of corticosteroids, leading to increased intraocular pressure and potential damage to the optic nerve. This type of glaucoma can happen to anyone who is exposed to high doses or prolonged use of steroids, especially if they are predisposed to glaucoma.
Mechanism: Steroid-induced glaucoma is a form of secondary open-angle glaucoma that results from the prolonged use of corticosteroids. Here is an overview of the mechanisms involved:

**Mechanism:**
1. **Intraocular Pressure (IOP) Elevation**: Corticosteroids can lead to increased intraocular pressure, which is a major risk factor for glaucoma. The elevated IOP occurs due to decreased outflow of aqueous humor through the trabecular meshwork.

**Molecular Mechanisms:**
1. **Extracellular Matrix (ECM) Remodeling**: Corticosteroids influence the expression of ECM proteins such as fibronectin, laminin, and collagen in the trabecular meshwork. Alterations in ECM composition can reduce aqueous humor outflow.

2. **Cytoskeletal Changes**: Steroids promote cytoskeletal rearrangements in trabecular meshwork cells. These changes impact the architecture and functionality of the outflow pathway, consequently increasing IOP.

3. **Cellular Stress Responses**: Exposure to corticosteroids can induce oxidative stress and apoptosis in trabecular meshwork cells, compromising their function and leading to reduced aqueous humor drainage.

4. **Gene Expression Modulation**: Corticosteroids regulate the expression of multiple genes related to ECM production, cell adhesion, and stress responses. This modulation occurs via glucocorticoid receptor signaling pathways, impacting trabecular meshwork cell behavior and function.

5. **Inflammatory Pathways**: Corticosteroids typically have anti-inflammatory effects, but chronic use may disrupt normal cellular repair mechanisms and immune responses in the eye, further contributing to abnormal aqueous humor dynamics.

In summary, steroid-induced glaucoma is primarily driven by the complex interplay of corticosteroid effects on ECM remodeling, cytoskeletal changes, cellular stress responses, gene expression, and inflammatory pathways in the trabecular meshwork, leading to elevated intraocular pressure.
Treatment: Steroid-induced glaucoma is treated by discontinuing or reducing the use of steroids if possible. If steroid therapy is essential, consideration may be given to switching to a less potent steroid or a formulation that is less likely to increase intraocular pressure. Medications such as topical ophthalmic beta-blockers, alpha agonists, carbonic anhydrase inhibitors, or prostaglandin analogs may be used to lower intraocular pressure. In some cases, laser therapy or surgical interventions like trabeculectomy or drainage implants may be necessary if medical management is not sufficient.
Compassionate Use Treatment: Steroid-induced glaucoma is a form of secondary glaucoma that results from the use of corticosteroids. When it comes to compassionate use, off-label, or experimental treatments, options may include:

1. **Compassionate Use Treatments**: These are typically considered for patients who have not responded to standard treatments and have severe vision loss.
- **Surgical Options**: For advanced cases, various surgical interventions such as trabeculectomy or tube shunt surgery may be considered.

2. **Off-Label Treatments**: These are not specifically approved for steroid-induced glaucoma but may be used based on clinical discretion.
- **Rho Kinase Inhibitors**: Drugs like netarsudil may be used off-label to lower intraocular pressure when traditional medications are insufficient.
- **Brimonidine**: Though primarily indicated for open-angle glaucoma, it might be used off-label due to its IOP-lowering properties.

3. **Experimental Treatments**: These are generally under clinical investigation and not widely available.
- **Neuroprotective Agents**: Certain compounds aiming to protect optic nerve function might be in experimental stages.
- **Gene Therapy**: Various approaches to correct the underlying cause at the genetic level are being explored but are not yet standard care.

It’s vital to manage steroid-induced glaucoma under the guidance of an ophthalmologist to tailor treatment based on individual patient needs and response to therapy.
Lifestyle Recommendations: For steroid-induced glaucoma, lifestyle recommendations include:

1. **Regular Eye Check-ups**: Schedule frequent eye examinations to monitor intraocular pressure and the health of the optic nerve.

2. **Medication Adherence**: Follow the prescribed treatment plan meticulously to manage intraocular pressure.

3. **Healthy Diet**: Consume a diet rich in antioxidants, fruits, and vegetables to support overall eye health.

4. **Exercise**: Engage in regular, moderate exercise to improve blood flow to your eyes and reduce intraocular pressure.

5. **Avoid Steroids**: Minimize or avoid the use of steroids unless absolutely necessary and always under a doctor's supervision.

6. **Hydration**: Stay well-hydrated, but avoid consuming large amounts of fluids in a short period to prevent spikes in intraocular pressure.

7. **Stress Management**: Practice stress-reducing techniques like yoga and meditation, as stress can impact eye health.

8. **Protective Eyewear**: Use protective eyewear to shield your eyes from injury and UV rays.

By following these recommendations, individuals with steroid-induced glaucoma can better manage their condition and maintain eye health.
Medication: Steroid-induced glaucoma is typically managed by discontinuing or reducing the steroid medication under the guidance of a healthcare provider. Additional treatments may include:

1. **Topical Medications**: Eye drops such as prostaglandin analogs, beta-blockers, alpha agonists, and carbonic anhydrase inhibitors to lower intraocular pressure (IOP).
2. **Laser Therapy**: Procedures like selective laser trabeculoplasty (SLT) to improve drainage of fluid from the eye.
3. **Surgery**: In cases where other treatments are ineffective, surgical options like trabeculectomy or the placement of drainage implants may be considered.

Regular monitoring by an ophthalmologist is crucial for managing this condition effectively.
Repurposable Drugs: Steroid-induced glaucoma is a form of secondary open-angle glaucoma that results from the prolonged use of corticosteroids. While there are currently no definitive repurposable drugs specifically approved for steroid-induced glaucoma, some drugs used for other types of glaucoma might be considered. These include:

1. **Prostaglandin analogs** (e.g., latanoprost, bimatoprost) – These drugs increase the outflow of aqueous humor, helping to reduce intraocular pressure.
2. **Beta-blockers** (e.g., timolol, betaxolol) – These reduce aqueous humor production.
3. **Carbonic anhydrase inhibitors** (e.g., dorzolamide, brinzolamide) – These also reduce aqueous humor production.
4. **Alpha agonists** (e.g., brimonidine) – These both reduce aqueous humor production and increase uveoscleral outflow.

Research into repurposing other drugs is ongoing, but clinical consultation is essential for personalized treatment.
Metabolites: Steroid-induced glaucoma is a type of secondary open-angle glaucoma that occurs due to prolonged use of corticosteroids. The metabolites in question are those produced by the metabolism of corticosteroids in the body. These corticosteroid metabolites can influence intraocular pressure (IOP), leading to an increase that may damage the optic nerve and result in glaucoma. Management of steroid-induced glaucoma typically involves discontinuing the corticosteroid treatment, if possible, and using medications or surgical options to lower the IOP.
Nutraceuticals: For steroid-induced glaucoma, nutraceuticals—a category of food-derived products that offer potential health benefits—are generally not well studied or established as effective treatments. Management primarily involves discontinuing the use of steroids, where possible, and utilizing traditional glaucoma treatments like intraocular pressure-lowering medications. Always consult with a healthcare professional for appropriate management strategies.
Peptides: Steroid-induced glaucoma is a form of secondary open-angle glaucoma resulting from prolonged use of corticosteroids. It involves increased intraocular pressure (IOP) due to impaired aqueous humor outflow. Key therapeutic targets can include peptides that reduce inflammation or improve outflow, though their clinical use is still under investigation. Nanotechnology-based solutions, such as nanoparticle drug delivery systems, are also being explored to enhance the efficacy and reduce the side effects of conventional treatments for managing elevated IOP.