How do steroids affect your eye health?
Steroids are commonly prescribed for various inflammatory and autoimmune conditions. While they are very effective at treating these conditions, they can significantly impact the health of your eyes. They particularly increase the risk of cataracts (a clouding of the eye) and glaucoma (increased pressure inside the eye, which can lead to optic nerve damage). By understanding these risks and managing them effectively, you can greatly increase your chances of maintaining good eye health during your steroid therapy.
Glaucoma
This condition occurs when the liquid contained within the eye cannot drain out of the eye in an efficient manner. This leads to an increase in the pressure within the eye. If high enough, this “intraocular hypertension” (high pressure within the eye) puts potentially damaging pressure on the optic nerve. The optic nerve is the crucial conduit of vision signals to the brain, where those signals are interpreted - essentially allowing the eye to “see”.
Elevated pressure on the optic nerve can cause irreversible damage to the nerve and vision loss if not properly managed.
Steroids can cause intraocular hypertension and, by extension, lead to ocular nerve damage.
Cataracts
Long-term steroid use can also lead to the development of cataracts, a condition in which proteins in the lens of the eye - the eye’s focusing mechanism - cause clouding of the vision and difficulty seeing clearly. The risks of cataracts grow with increased dosage and length of treatment. In one study of rheumatoid arthritis patients, as many as 42% of long-term steroid users developed cataracts.
There are several things that can increase a patient's risk of developing steroid-induced glaucoma. These include:
Existing glaucoma or a family history of glaucoma
Patients who already have “primary open-angle glaucoma” or those with a family history of glaucoma are more susceptible to developing complications of glaucoma if started on steroids.
High myopia
People with severe nearsightedness (where objects nearby are clear but those that are far away look blurry) are also more susceptible to glaucoma.
Age
Both very young children and older adults are at higher risk of glaucoma.
Diabetes
Patients with type 1 diabetes are also more likely to develop steroid-induced glaucoma.
Previous steroid response
Patients who have a history of raised eye pressure in response to steroids should be monitored particularly carefully for a return or worsening of the condition if steroids are started again.
Why does this happen?
Currently, there is no confirmed scientific explanation for why steroids cause cataracts and glaucoma. With growing awareness of steroid side effects among patients and the medical community, we hope to see more research and gain greater understanding in the years ahead. For now, if you’re taking steroids, it’s well worth paying close attention to any changes in your eyesight and discussing these with our doctor as soon as you can.
Symptoms of these steroid-induced eye complications can be very subtle initially, making regular eye check-ups essential.
What to look out for
The symptoms of steroid-induced eye conditions may not cause noticeable changes to your vision immediately. Over time, however, these changes - subtle at first - can lead to significant vision loss if undetected and left untreated. For this reason, regular check-ups are essential to detect early signs of increased pressure or lack of adequate fluid drainage in your eyes.
Dr George Papaliodis, an ocular immunologist at Harvard Medical School and the Massachusetts Eye and Ear Infirmary, treats patients with a range of inflammatory eye disorders, including conditions such as uveitis and scleritis - disorders for which steroids remain an important part of the treatment strategy to protect the eyes and preserve vision.
“Sadly, any exposure to steroids carries an increased risk of cataracts and glaucoma, and there's really no way from a patient's perspective to protect the lens of the eye from developing cataracts or to lower eye pressure.”
“It is therefore critical to ensure that eye health is proactively monitored and that patients work with their doctors to minimize their exposure to steroids by ensuring the lowest doses needed to control a condition are taken for the shortest amount of time.”
Top tips for managing eye health
Regular monitoring
Talk to your doctor and make sure you are having your eye pressure and sight checked regularly. Initially, a consultation with an ophthalmologist (eye specialist) is recommended within 3 to 6 weeks of starting your steroid treatment.
Medication management
If raised eye pressure is detected in one or both of your eyes, your medical team will look at the options available to you, which may include topical ophthalmic agents that can lower intraocular pressure, or reducing or discontinuing your steroid therapy. It’s important that you do not make changes to your own medication.
Surgical options
When eye pressure becomes a persistent problem (and eyedrops are unable to regulate), it may be necessary to consider surgery to reduce it.
“There are really no options that can protect the eye and any exposure to steroids carries risk. The duration, the dose, the time and the strength of the steroid all influence risk. From a patient's perspective, there's nothing proactive or predictive that would reduce those risks, but ensuring eye health is regularly monitored can ensure those risks don’t cause lasting damage.”
The bottom line
Steroids are effective for treating inflammation and autoimmune diseases but pose significant risks to eye health, particularly in increasing the risk of glaucoma and cataracts. With regular monitoring, careful management of your medications and collaboration with eye specialists, you can work to mitigate these risks and increase your chances of maintaining normal healthy vision.
Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.