Topical Corticosteroid Use in Children Can Cause Blindness

Case Report

J Pediatr & Child Health Care. 2020; 5(1): 1032.

Topical Corticosteroid Use in Children Can Cause Blindness

Henriques S1*, Xavier C2, Vaz FT1 and Brito C2

1Department of Ophthalmology, Hospital Prof. Doutor Fernando Fonseca, Portugal

2Departamento of Ophthalmology, Centro Hospitalar Universitário de Lisboa Central, Portugal

*Corresponding author: Susana Pinto Henriques, Ophthalmology Department, Hospital Prof. Doutor Fernando Fonseca, E.P.E .IC 19, 2720-276 Amadora, Portugal

Received: April 01, 2020; Accepted: April 14, 2020; Published: April 21, 2020


Introduction: Glaucoma is a degenerative optic neuropathy, usually associated with elevated Intraocular Pressure (IOP), which causes progressive damage of neuronal cells that ultimately causes irreversible blindness. The use of corticosteroids may lead to glaucoma. In young children glaucoma may cause irreversible enlargement of the eye.

Case Report: A case is presented of an 8-month-old male medicated with topical corticosteroids for symptoms related to nasolacrimal obstruction of the left eye. He had an increase in the corneal diameter, axial length and a greater cup-disk ratio of the left eye. Although an elevated IOP was never observed after stopping corticosteroid, these signs might indicate there has been ocular hypertension in the past, much likely associated with corticosteroids.

Discussion: Whenever possible corticosteroids should be avoided, especially in children, where their effect on IOP may be greater. If not possible, regular ophthalmologic evaluation and IOP monitoring is crucial, since devastating ocular changes and blindness can occur.

Keywords: Corticosteroids; Glaucoma; Glaucoma risk; Steroid-induced glaucoma; Pediatric glaucoma

Case Presentation

An 8-month-old male was medicated since newborn with a combination of prednisolone, neomycin and polymyxin B (Conjunctilone-S®, Allergan) eye drops, twice a day, for presumed epiphora and recurrent conjunctivitis related to obstruction of the nasolacrimal canal of the Left Eye (LE).

The patient was referred to an ophthalmologist because recurrent bilateral conjunctivitis and a suspicion of progressive enlargement of the LE (Figure 1). Topical medication was withdrawed and lacrimal pathway was probed with resolution of signs of obstruction. The observation under general anesthesia was performed, which showed transparent corneas, IOP of 8mmHg on the Right Eye (RE) and 10mmHg on the LE, a corneal diameter of 12mm (RE) and 13mm (LE) and axial length of 21.15mm (RE) and 22.50mm (LE). Fundoscopy showed no excavation on RE and a greater cup-disk ratio on the LE of 0.4 (Figure 2). Gonioscopy showed an open angle 360o on both eyes. The objective refraction under cycloplegia was +3.00 (RE) and +1.00-0.50x180o (LE). Although the IOP was within normal values, there was an asymmetry of the eyeballs, with buphthalmos and a greater cup-disk ratio of the LE, suggestive of glaucoma.

Citation: Henriques S, Xavier C, Vaz FT and Brito C. Topical Corticosteroid Use in Children Can Cause Blindness. J Pediatr & Child Health Care. 2020; 5(1): 1032.