Symptoms and "Sneaky" Sources of Steroid Exposure

Steroid-induced glaucoma is often referred to as a silent thief of sight ^[1]. This is because high pressure inside the eye typically does not cause pain, redness, or immediate vision changes ^[2]. By the time a person notices a problem, significant damage may have already occurred. Understanding the subtle signs and identifying “hidden” sources of steroids is the first step in protecting your vision.

The Lack of Symptoms

In its early and moderate stages, steroid-induced glaucoma is almost always asymptomatic, meaning you will not feel anything unusual ^[1]. The eye does not have “pressure sensors” that notify you when the internal fluid is building up.

If the condition advances without treatment, you may experience:

• Peripheral Vision Loss: The edges of your vision begin to fade, a process so gradual it often goes unnoticed ^[3].
• Tunnel Vision: In advanced stages, it may feel as though you are looking through a narrow tube as your side vision disappears completely ^[2].
• Blurred Vision: If eye pressure spikes very high very quickly, the cornea (the clear front window of the eye) can swell, causing vision to become hazy or blurry ^[3].

“Sneaky” Sources of Steroids

Many patients are surprised to learn that medications used far away from the eyes can still affect eye pressure. Steroids can be absorbed into your bloodstream and travel to the eye’s drainage system ^[4]. Common sources include:

• Dermatological Creams: Over-the-counter or prescription creams for eczema, psoriasis, or rashes ^[5].
• Nasal Sprays: Medications used daily for seasonal allergies or hay fever ^[4].
• Inhalers: Standard treatments for asthma or COPD (Chronic Obstructive Pulmonary Disease) ^[6].
• Joint Injections: Cortisone shots given by an orthopedist for knee, hip, or shoulder pain ^[7].
• Oral Medications: Pills like prednisone used for autoimmune flares or severe allergic reactions ^[8].

The Challenge of Intravitreal Implants

A specific type of treatment called an intravitreal implant (such as Ozurdex) presents a unique situation ^[9]. These are small devices injected directly into the vitreous (the gel-like center of the eye) to treat retinal conditions.

Unlike eye drops, which you can stop using if your pressure rises, an implant is designed to stay in the eye and release medication slowly over several months ^[10]. Pressure spikes from these implants usually peak between 30 and 90 days after the injection ^[9]. If you have an implant, your doctor will need to monitor your pressure closely for several months, as the “source” of the steroid cannot be easily removed ^[11].