CORTISONIC GLAUCOMA: DRAMATIC EVOLUTION OF VERNAL KERATO-CONJUNCTIVITIS ABOUT A CASE REPORT

Cortisonic glaucoma is an iatrogenic secondary glaucoma induced by corticosteroids administered locally or systemically in an uncontrolled manner, most often during chronic inflammatory conditions, notably allergic conjunctivitis.

The aim of our work is to show the importance of regular monitoring of children treated for vernal keratoconjunctivitis with local corticosteroids, and to make parents aware of the seriousness of these side effects.

We report the case of an 11-year-old child presenting with cortisonic glaucoma on vernal kerato-conjunctivitis.

We report the case of an 11-year-old child presenting with cortisonic glaucoma on vernal kerato-conjunctivitis.

Results

Its about a 11-year-old child, the last of 4 siblings, had been treated for vernal keratoconjunctivitis since the age of 6. He had been put on long-term local corticosteroids without regular follow-up, and his family had not been made aware of the seriousness of long-term local corticosteroids.

Ophthalmological examination revealed  visual acuity with counting finger in the right eye  and 6/10 in the left eye, conjunctival hyperemia, deep anterior chamber, posterior subcapsular cataract in both eyes, ocular tone of 30mmhg in the right eye and 25mmhg in the left eye  and fundus excavation of 8/10 in the right eye  and 7/10 in the left eye.

Corticosteroid treatment was stopped and the patient was put on oral and local hypotonizing therapy with dorzolamide + timolol + latanoprost.

Ocular tone remained high despite maximum hypotonizing treatment, and the patient was subsequently operated on by ODG filtration surgery,

Post-operative management was straightforward, with ocular tone stabilizing at 10mmhg, and the patient was put on 2% cyclosporine at a dose of 2 drops per day with a preservative-free artificial tear-based surface treatment, the patient is scheduled for ODG cataract surgery.

Discussion

 Cortisonic glaucoma is a reality, with an estimated frequency of 1.4% of all glaucomas. It is most often associated with prolonged local corticosteroid therapy, given for chronic ocular conditions, of which vernal conjunctivitis is the main cause.

Hypertonia appears within a few days, but maximum pressure is reached after 2 to 3 weeks of corticosteroid therapy.

The combination of cataract and cortisone-induced glaucoma is relatively frequent during local corticosteroid therapy, and the prognosis depends above all on early diagnosis and hypotonizing treatment to normalize blood pressure and halt destruction of the optic fibers.

Surgery remains the last resort when medical treatment is ineffective.

Cortisone-induced glaucoma in vernal keratoconjunctivitis is a serious but preventable complication, hence the importance of correct management and regular monitoring of patients on local corticosteroid therapy, as well as raising family awareness of the harmful effects of self-medicated or uncontrolled corticosteroid treatment.