Corticosteroid-Induced Glaucoma In Keratoconjunctivitis In Children

Keratoconjunctivitis is an allergic inflammation of the conjunctiva that mainly affects children and young adults. Although the appearance of the disease is seasonal, keratoconjunctivitis is often persistent in hot and tropical climates. Eighty-five percent of patients with keratoconjunctivitis will require topical corticosteroids at some point during their disease, exposing their eyes to a higher risk of permanent visual impairment, especially in children, due to complications such as corneal scarring, cataract formation, and especially steroid-induced glaucoma, which is the subject of our case.

This is a case study of a patient followed for 3 months at the Ophthalmology Center of the Cheikh Zaid Hospital in Rabat.

We report the case of a 10-year-old child with a history of allergic keratoconjunctivitis treated with long-term topical corticosteroids and keratoconus, in whom clinical examination revealed a visual acuity of 1/10 in the right eye, a intraocular pressure  of 22mmHg in the right eye and 27mmHg in the left eye, bilateral corticonuclear cataract, conjunctival papillae, and corneal neovascularization. Fundus examination revealed an advanced excavation in the left eye. The diagnosis of steroid-induced glaucoma associated with stage 4 keratoconus was made and hypotonic treatment was prescribed.

The diagnosis of steroid-induced glaucoma is made when the IOP is higher than 21 mmHg for more than three consecutive readings, in the absence of other possible causes of high IOP, accompanied by a concomitant change in the optic nerve head and a glaucomatous visual field anomaly. The diagnosis is confirmed by OCT analysis of the optic fiber layer.

The management consists, first and foremost, in the immediate discontinuation of topical corticosteroid therapy and the initiation of hypotonic medical treatment according to the patient's IOP readings and medical history.

Steroid-induced glaucoma is a rare but dangerous . It is all the more dangerous when it affects children. The pathogenesis is not yet understood, but hypertension may be caused by the accumulation of mucopolysaccharides in the trabeculum. It has been found that a certain genetic predisposition is necessary to develop steroid-induced glaucoma.Steroid-induced glaucoma is an iatrogenic secondary glaucoma of pharmacogenic origin induced by corticosteroids, especially topically. In our context,the main cause was the abusive use of corticosteroids following keratoconjunctivitis.

A rapid control of IOP is crucial to detect any corticosteroid-induced glaucoma requiring prompt and adequate management to stop the progression of optic nerve damage.