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PubMed This is a summary of 16 peer-reviewed journal articles Updated
Ophthalmology

Treatment Strategy: Managing Your Eye Pressure

At a Glance

The first step in treating steroid-induced glaucoma is safely adjusting, tapering, or switching the steroid medication with your doctor's help. If eye pressure remains high, treatments like ROCK inhibitor eye drops, SLT laser therapy, or minimally invasive glaucoma surgery can help lower it.

The goal of treating steroid-induced glaucoma is to lower your eye pressure before it causes permanent damage to your vision. Doctors follow a specific “decision tree” to manage this condition, starting with the most conservative options and moving toward advanced procedures if necessary.

Step 1: Adjusting the Steroid

The first and most effective step is often to remove the cause [1]. Your eye doctor will work with your other healthcare providers to stop, taper, or switch the steroid medication.

IMPORTANT SAFETY WARNING: You must never stop or adjust your steroid medications on your own without direct instruction from your prescribing physician. Abruptly stopping systemic steroids can cause a severe disease flare or a potentially life-threatening adrenal crisis.

  • Taper or Stop: If safely possible, your doctor will slowly reduce the dose [2].
  • Switch to “Soft” Steroids: If you still need treatment for inflammation, your doctor may switch you to soft steroids such as loteprednol (Lotemax) or fluorometholone [3][4]. These are broken down quickly by the eye, making them much less likely to raise eye pressure than “strong” steroids like prednisolone or dexamethasone [5][6].

Step 2: Medical Therapy and ROCK Inhibitors

If adjusting the steroids isn’t enough, your doctor will prescribe eye drops to lower the pressure. While traditional glaucoma drops (such as prostaglandin analogs) work by either reducing fluid production or increasing alternative drainage pathways, a newer class of medication called ROCK inhibitors (such as netarsudil) specifically targets the eye’s primary “clogged drain” [7].

They help reverse the structural changes and cellular stress in the trabecular meshwork caused by steroids, essentially helping the eye’s natural drainage system function properly again [7][8].

Step 3: Laser Treatment

If medications are not sufficient, Selective Laser Trabeculoplasty (SLT) may be recommended [9]. This is a quick, office-based laser procedure that uses a “cold” laser to stimulate the eye’s drainage tissue. It is a very effective and safe way to lower pressure without daily drops [10]. However, it is important to note that while SLT is highly effective for primary glaucoma, its effectiveness for steroid-induced glaucoma can vary depending on how heavily clogged the trabecular meshwork has become [11].

Step 4: Surgical Options

In severe or “intractable” cases where pressure remains dangerously high, surgery may be necessary.

  • MIGS (Minimally Invasive Glaucoma Surgeries): Procedures like GATT (Goniotomy-assisted transluminal trabeculotomy) involve creating a small opening to bypass the blockage, and are a safe and common choice for steroid-induced glaucoma [12][13]. Other surgeries, like a traditional trabeculotomy, physically clear the blocked channels [14][15].
  • Traditional Glaucoma Surgeries: If minimally invasive techniques are not sufficient, established procedures such as a trabeculectomy or the implantation of tube shunts can be used. These surgeries create a completely new drainage pathway for the fluid and are highly effective for severe, intractable pressure spikes [16].

Common questions in this guide

Can I stop taking my steroids if my eye pressure is high?
No, you should never stop or adjust systemic steroid medications on your own. Abruptly stopping steroids can cause a severe disease flare or a life-threatening adrenal crisis, so always work directly with your prescribing doctor.
What are soft steroids for the eye?
Soft steroids, such as loteprednol or fluorometholone, are medications that the eye breaks down quickly. They effectively treat inflammation but are much less likely to cause a dangerous spike in eye pressure compared to stronger steroids.
How do ROCK inhibitor eye drops work for steroid-induced glaucoma?
ROCK inhibitors are a newer class of eye drops that specifically target the eye's primary drainage system, which becomes clogged by steroid use. These drops help reverse cellular stress in the drainage tissue, allowing fluid to flow properly and lowering eye pressure.
What happens if eye drops don't lower my eye pressure enough?
If medications aren't sufficient, your doctor may recommend Selective Laser Trabeculoplasty (SLT), a quick office-based laser procedure to stimulate the eye's drainage tissue. If the pressure remains dangerously high, minimally invasive or traditional glaucoma surgeries may be necessary.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Can we switch my current steroid to a 'soft' alternative like loteprednol or fluorometholone?
  2. 2.Would a ROCK inhibitor like netarsudil be appropriate for my case to help reverse the changes in my eye's drainage system?
  3. 3.If my pressure doesn't come down after stopping the steroids, is Selective Laser Trabeculoplasty (SLT) a good next step for me?
  4. 4.Am I a candidate for a minimally invasive surgery like GATT if eye drops are not enough?

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 (16)
  1. 1

    Long-Term Risk of Steroid-Induced Ocular Hypertension/Glaucoma With Topical Prednisolone Acetate 1% After Descemet Stripping Endothelial Keratoplasty.

    Price MO, Price DA, Price FW

    Cornea 2024; (43(3)):323-326 doi:10.1097/ICO.0000000000003312.

    PMID: 37155339
  2. 2

    Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study.

    Pacella E, Loffredo L, Malvasi M, et al.

    Clinical ophthalmology (Auckland, N.Z.) 2020; (14()):3611-3617 doi:10.2147/OPTH.S265691.

    PMID: 33154620
  3. 3

    [Perioperative/Postoperative Anti-Inflammatory Therapy During/After Corneal Surgery/Transplantation].

    Bachmann BO, Pleyer U, Maier PC, et al.

    Klinische Monatsblatter fur Augenheilkunde 2019; (236(5)):653-661 doi:10.1055/a-0864-4793.

    PMID: 31096284
  4. 4

    Real world use of loteprednol etabonate ophthalmic gel 0.5% in cases representative of comorbid pathologies responding to minimally invasive glaucoma surgery.

    Sheppard JD, Singh IP

    Clinical ophthalmology (Auckland, N.Z.) 2019; (13()):1279-1288 doi:10.2147/OPTH.S206424.

    PMID: 31409967
  5. 5

    Pattern of steroid misuse in vernal keratoconjunctivitis resulting in steroid induced glaucoma and visual disability in Indian rural population: An important public health problem in pediatric age group.

    Sen P, Jain S, Mohan A, et al.

    Indian journal of ophthalmology 2019; (67(10)):1650-1655 doi:10.4103/ijo.IJO_2143_18.

    PMID: 31546501
  6. 6

    Impact of the Topical Ophthalmic Corticosteroid Loteprednol Etabonate on Intraocular Pressure.

    Sheppard JD, Comstock TL, Cavet ME

    Advances in therapy 2016; (33(4)):532-52 doi:10.1007/s12325-016-0315-8.

    PMID: 26984315
  7. 7

    Anti-fibrotic activity of a rho-kinase inhibitor restores outflow function and intraocular pressure homeostasis.

    Li G, Lee C, Read AT, et al.

    eLife 2021; (10()).

    PMID: 33783352
  8. 8

    Effects of Netarsudil on Actin-Driven Cellular Functions in Normal and Glaucomatous Trabecular Meshwork Cells: A Live Imaging Study.

    Keller KE, Kopczynski C

    Journal of clinical medicine 2020; (9(11)) doi:10.3390/jcm9113524.

    PMID: 33142742
  9. 9

    Outcomes of selective laser trabeculoplasty in corticosteroid-induced ocular hypertension and glaucoma.

    AlObaida I, Al Owaifeer AM, Alotaibi H, et al.

    European journal of ophthalmology 2022; (32(3)):1525-1529 doi:10.1177/11206721211023310.

    PMID: 34096363
  10. 10

    Efficacy and Safety of High-Energy Selective Laser Trabeculoplasty for Steroid-Induced Glaucoma in Patients with Quiescent Uveitis.

    Xiao J, Zhao C, Liang A, et al.

    Ocular immunology and inflammation 2021; (29(4)):766-770 doi:10.1080/09273948.2019.1687730.

    PMID: 31902258
  11. 11

    Selective laser trabeculoplasty in steroid-induced and uveitic glaucoma.

    Zhou Y, Pruet CM, Fang C, Khanna CL

    Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2022; (57(4)):277-283 doi:10.1016/j.jcjo.2021.05.006.

    PMID: 34119463
  12. 12

    Gonioscopy-assisted Transluminal Trabeculotomy (GATT) is An Effective Procedure for Steroid-induced Glaucoma.

    Boese EA, Shah M

    Journal of glaucoma 2019; (28(9)):803-807 doi:10.1097/IJG.0000000000001317.

    PMID: 31259756
  13. 13

    Gonioscopy-assisted transluminal trabeculotomy for intractable ocular hypertension after repeated intravitreal dexamethasone implant injections.

    Ucgul RK, Olgun AO, Akdeniz ZB, et al.

    International ophthalmology 2025; (45(1)):325 doi:10.1007/s10792-025-03698-w.

    PMID: 40773070
  14. 14

    Gonioscopy-Assisted Transluminal Trabeculotomy and Goniotomy, With or Without Concomitant Cataract Extraction, in Steroid-Induced and Uveitic Glaucoma: 24-Month Outcomes.

    Chen RI, Purgert R, Eisengart J

    Journal of glaucoma 2023; (32(6)):501-510 doi:10.1097/IJG.0000000000002183.

    PMID: 36795532
  15. 15

    Goniotomy for Steroid-Induced Glaucoma: Clinical and Tonographic Evidence to Support Therapeutic Goniotomy.

    Choi EY, Walton DS

    Journal of pediatric ophthalmology and strabismus 2015; (52(3)):183-8 doi:10.3928/01913913-20150427-05.

    PMID: 26053210
  16. 16

    Outcomes of Minimally Invasive Glaucoma Surgery, Trabeculectomy, and Tube Shunt Surgery in Secondary Glaucoma: IRIS® Registry Analysis.

    Fujita A, Zebardast N, Lorch AC, et al.

    American journal of ophthalmology 2026; (289()):7-19 doi:10.1016/j.ajo.2026.05.011.

    PMID: 42140464

This page provides educational information about managing steroid-induced glaucoma. Always consult your ophthalmologist and prescribing doctor before making any changes to your steroid medications.

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