Upon evaluating the clinical features, treatment outcomes and blindness associated with steroid-induced glaucoma (SIG) due to vernal keratoconjunctivitis (VKC) therapy, Indian researchers found that the disease predominantly affected adolescent males and that one-third of participants needed surgery and one-third went blind due to SIG.

Glaucoma was diagnosed based on intraocular pressure (IOP) greater than or equal to 22mm Hg on two consecutive visits (ocular hypertension), glaucomatous optic disc damage or both. Blindness was defined as best-corrected visual acuity of less than or equal to 20/400 or visual field less than 10°.

 Of the 4,062 VKC patients, 2.24% had SIG, 87% of which were men. The median age at onset of VKC was 12. At presentation, the median duration of VKC was 48 months (between 24 and 72 months), and the median duration of steroid usage was 24 months (between 12 and 36 months). The median cup-to-disc ratio (CDR) was 0.9, and the median mean deviation was -21.9dB. Also at presentation, 31.8% of those with SIG were already bilaterally blind.

The team found that IOP was medically controlled in 66% of eyes and that 34% of eyes needed glaucoma surgery. They note that a high presenting IOP and an increased duration of steroid usage were significantly associated with the need for glaucoma surgery. They add that a higher CDR at presentation was significantly associated with blindness.

Senthil S, Thakur M, Rao HL, et al. Steroid-induced glaucoma and blindness in vernal keratoconjunctivitis. Br J Ophthalmol. May 4, 2019. [Epub ahead of print].