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PubMed This is a summary of 12 peer-reviewed journal articles Updated
Ophthalmology

Who is Most at Risk?

At a Glance

Children, people with severe nearsightedness, and those with a family history of glaucoma are at the highest risk for steroid-induced glaucoma. Even non-eye steroids like nasal sprays, asthma inhalers, and skin creams can trigger dangerous eye pressure spikes, requiring close monitoring.

While anyone can develop high eye pressure from steroids, certain people have a much higher biological “sensitivity” to these medications. Identifying your risk level early can help you and your care team decide how frequently your eye pressure needs to be monitored.

Vulnerability in Children

Children are among the most vulnerable to steroid-induced glaucoma [1]. Unlike adults, children can experience pressure spikes that are faster, higher, and more severe [2].

Crucially, in children, this reaction is not limited to eye drops. They can develop dangerously high eye pressure from “sneaky” sources such as:

  • Nasal Sprays: Used for seasonal allergies [1].
  • Skin Creams: Used for eczema or rashes [3].
  • Inhalers: Used for asthma or respiratory issues [4].

Because children often cannot articulate subtle changes in their vision, it is vital for parents to ensure a child’s eye pressure is checked if they are on any long-term steroid therapy, regardless of how the medication is delivered [1].

High-Risk Eye Factors

Your eye’s physical structure and your genetic history play a major role in how you respond to steroids.

  • Pre-existing Glaucoma: If you already have Primary Open-Angle Glaucoma (POAG), your risk of being a “high responder” is nearly 90% [5].
  • Family History: Having a first-degree relative (parent or sibling) with glaucoma significantly increases the chance that you will also have a strong pressure response to steroids [6].
  • High Myopia: People with high myopia (severe nearsightedness, typically requiring a strong prescription) are at increased risk [7]. Their eyes often have structural differences in the drainage system that make them more sensitive to pressure changes [8].

Systemic Conditions and Steroid Load

Some medical conditions require long-term, high-dose steroid use to prevent serious health complications. In these cases, the risk of glaucoma is often a trade-off for managing life-threatening or sight-threatening inflammation. Common conditions include:

  • Organ Transplants: Kidney transplant recipients often take long-term steroids to prevent organ rejection [9].
  • Uveitis: Chronic inflammation inside the eye itself [10].
  • Behçet’s Disease: A rare disorder that causes blood vessel inflammation throughout the body [11].

For these patients, the goal is not always to stop the steroid, but to “manage through” the side effects by using pressure-lowering drops or other treatments while the steroids do their necessary work [12]. To explore these options, read about the Treatment Strategy.

Common questions in this guide

Can steroid nasal sprays or skin creams cause glaucoma?
Yes. While steroid eye drops are the most direct route, absorbing steroids through nasal sprays, asthma inhalers, or skin creams can also cause dangerous spikes in eye pressure. This is especially true for children, who are highly sensitive to steroids in any form.
Why are children at higher risk for steroid-induced glaucoma?
Children tend to have a much stronger biological sensitivity to steroids than adults. Their eye pressure can spike faster, reach higher levels, and cause more severe damage, often before they are able to notice or communicate any subtle changes in their vision.
Does having severe nearsightedness increase my risk of glaucoma from steroids?
Yes, people with high myopia (severe nearsightedness) are at an increased risk. Their eyes often have structural differences in the drainage system that make them much more sensitive to fluid pressure changes when using steroid medications.
What if I have a family history of glaucoma?
Having a first-degree relative, like a parent or sibling, with glaucoma significantly raises your chances of having a strong pressure response to steroids. If you have this family history, it is crucial to inform your doctor so your eye pressure can be closely monitored.
Can I stop taking my steroids if my eye pressure goes up?
Never stop taking prescribed steroids without consulting your doctor. For severe conditions like organ transplants or uveitis, steroids may be life-saving or sight-saving. Your eye doctor can often prescribe pressure-lowering eye drops to manage the glaucoma while you continue your necessary steroid treatment.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does my history of nearsightedness (myopia) or family history of glaucoma put me at higher risk for a steroid response?
  2. 2.Since my child is using a steroid nasal spray or skin cream, how often should their eye pressure be checked?
  3. 3.Is my current dosage of steroids for my systemic condition (like uveitis or a transplant) considered 'high risk' for my eyes?
  4. 4.Are there non-steroidal alternatives that could manage my inflammation while protecting my vision?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (12)
  1. 1

    The short-term effects of intranasal steroids on intraocular pressure in pediatric population.

    Ozturk T, Durmaz Engin C, Koksaldi S, Arikan G

    International ophthalmology 2022; (42(12)):3821-3827 doi:10.1007/s10792-022-02402-6.

    PMID: 35819739
  2. 2

    Steroid-induced glaucoma in the pediatric population.

    Nuyen B, Weinreb RN, Robbins SL

    Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2017; (21(1)):1-6 doi:10.1016/j.jaapos.2016.09.026.

    PMID: 28087345
  3. 3

    Risk of ocular hypertension in children treated with systemic glucocorticoid.

    Krag S, Larsen D, Albertsen BK, Glerup M

    Acta ophthalmologica 2021; (99(8)):e1430-e1434 doi:10.1111/aos.14820.

    PMID: 33629533
  4. 4

    Effect of Long-term Oral Steroids on Intraocular Pressure in Children With Autoimmune Hepatitis: a Prospective Cohort Study.

    Prasad D, Poddar U, Kanaujia V, et al.

    Journal of glaucoma 2019; (28(10)):929-933 doi:10.1097/IJG.0000000000001352.

    PMID: 31453897
  5. 5

    Effect of intravitreal injection of dexamethasone 0.7 mg (Ozurdex®) on intraocular pressure in patients with macular edema.

    Mazzarella S, Mateo C, Freixes S, et al.

    Ophthalmic research 2015; (54(3)):143-9 doi:10.1159/000438759.

    PMID: 26394206
  6. 6

    Characterizing the expression profile of Dexras1 in human trabecular meshwork cells.

    Chen C, Han J, Sanchez L, et al.

    Biochemistry and biophysics reports 2025; (43()):102077 doi:10.1016/j.bbrep.2025.102077.

    PMID: 40546349
  7. 7

    Axial Length as a Risk Factor for Steroid-Induced Ocular Hypertension.

    Choi W, Kim JD, Bae HW, et al.

    Yonsei medical journal 2022; (63(9)):850-855 doi:10.3349/ymj.2022.63.9.850.

    PMID: 36031785
  8. 8

    Risk of Elevated Intraocular Pressure With Difluprednate in Patients With Non-Infectious Uveitis.

    Yakin M, Kumar A, Kodati S, et al.

    American journal of ophthalmology 2022; (240()):232-238 doi:10.1016/j.ajo.2022.03.026.

    PMID: 35381204
  9. 9

    Steroid-induced glaucoma in kidney transplant recipients: a prospective cross-sectional study.

    Jain VK, Agarwal R, Maroof L, et al.

    Romanian journal of ophthalmology 2024; (68(4)):362-366 doi:10.22336/rjo.2024.66.

    PMID: 39936059
  10. 10

    Intraocular Pressure Elevation After Posterior Subtenon Triamcinolone Acetonide Injection in Pediatric Non-Infectious Uveitis.

    Yalcinsoy KO, Ozdal PC, Sen E, Elgin U

    Beyoglu eye journal 2022; (7(4)):298-303 doi:10.14744/bej.2022.97752.

    PMID: 36628084
  11. 11

    Aetiology and clinical characteristics of uveitic glaucoma in Turkish patients.

    Altan C, Basarir B

    International ophthalmology 2021; (41(6)):2225-2234 doi:10.1007/s10792-021-01783-4.

    PMID: 33730317
  12. 12

    Steroid-induced Glaucoma: An Avoidable Irreversible Blindness.

    Phulke S, Kaushik S, Kaur S, Pandav SS

    Journal of current glaucoma practice 2017; (11(2)):67-72 doi:10.5005/jp-journals-l0028-1226.

    PMID: 28924342

This page provides information on risk factors for steroid-induced glaucoma for educational purposes only. Always consult your ophthalmologist or prescribing doctor before starting, stopping, or changing any steroid medications.

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