When The Misuse Of Topical Corticosteroids Eyedrops Leads To Severe Complications

Vernal keratoconjunctivitis (VKC) is a severe ocular surface disease. Its pathogenesis remains unclear.

Anti-allergic treatments are often ineffective in patients with severe VKC, which can result in sight-threatening complications such as shield ulcers, corneal scarring, plaques, dry eyes and secondary infections.

The long-term use of corticosteroids eyedrops by patients is often unsupervised and without proper monitoring, as a result, it can eventually lead to serious and dangerous problems.

The purpose of this work is to raise awareness about the importance of patient education regarding the use of corticosteroids eyedrops, particularly in chronic diseases, in order to prevent the adverse effects.

We report the case of a 12 y.o. child treated with anti-allergic and corticosteroids eyedrops for vernal keratoconjunctivitis, who was then lost to follow up. 

After 3 years, the patient returns to our center with red, itchy and tearing eyes, with a blurry vision, photophobia and visual field defect.

The corrected visual acuity is around 6/10 in the right eye and counting fingers (1m) in the left eye. 

The patient underwent a thorough slit-lamp examination, including intraocular pressure measurement, and retinal photography

Slit lamp examination of both eyes showed diffuse conjunctival injection with elevated intraocular pressure (30 mmHg), a bilateral corticonuclear cataract. Funduscopic examination reveals a pale optic disc with a large excavation.

Slit lamp examination of the left eye showed peri-limbal Horner-Trantas dots and superior superficial punctate keratopathy, without the presence of upper tarsal giant papillae

Other tests were performed to assess the degree of damage of the optic nerve and its impact on the visual field.

After safely tapering corticosteroids eyedrops and after a good control of intraocular pressure in both eyes, the patient underwent a cataract surgery under general anesthesia leading to a better visual acuity and a slight improvement of the visual field in both eyes.

VKC is a disease most common within patients in early to mid childhood, specially in hot and arid climates.

Patient education plays a crucial role in preventing the side effects of the long-term use of corticosteroids. Healthcare providers should ensure that patients understand the proper use, the correct dose, the duration and the potential side effects of these medications (Increased IOP, cataract and delayed wound healing). Regular follow-up appointments are necessary.

VKC is an important public health problem , it can result in significant damage to the cornea and conjunctiva.

Adequate treatment through good patient education and regular, long-term follow-up are essential to avoid adverse effects of long-term corticosteroid therapy (glaucoma, cataracts and opportunistic infections).

Before prescribing topical steroids eyedrops:

• Take an adequate clinical history.
• Exclude the three high risk situations : Glaucoma, cataract, underlying infection.
• Always monitor the intraocular pressure (IOP).
• Avoid long-term corticosteroid therapy as much as possible.
• Maintain a close follow up.