Irreversible visual loss secondary to excessive topical steroid use in eczema

Fat, Charles Lim; Leslie, Thorfinn

doi:10.3399/bjgp11x594054

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…29 In the current literature, the majority of reported associations between glaucoma and eczema are an increased incidence of glaucoma secondary to steroid-induced glaucoma from the use of topical glucocorticoids in the treatment of eczema. [30][31][32][33] However, both unadjusted and adjusted analyses in this study demonstrated associations of similar magnitude between eczema and decreased glaucoma prevalence, suggesting that steroid use was unlikely a significant confounding factor for the association between eczema and glaucoma in the NHANES population. Given that this study only included adults over age 40 and eczema is mainly a disease of childhood often with spontaneous remission by adolescence, 29,34 it is possible that eczema in adulthood has a different pathophysiologic mechanism that somehow leads to an association with decreased glaucoma prevalence.…”

Section: Discussionsupporting

confidence: 48%

Associations between factors related to atopic disease and glaucoma in the National Health and Nutrition Examination Survey

Tseng

Lee

et al. 2018

European Journal of Ophthalmology

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In National Health and Nutrition Examination Survey, self-reported cat ownership is associated with increased glaucoma prevalence, while a mildew/musty smell in home may have a borderline association with increased glaucoma prevalence. These findings are possibly related to laboratory associations identified in the same population and further studies are needed to identify potential mechanisms to explain these associations.

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Section: Discussionsupporting

confidence: 48%

Associations between factors related to atopic disease and glaucoma in the National Health and Nutrition Examination Survey

Tseng

Lee

et al. 2018

European Journal of Ophthalmology

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“…6 Two main mechanisms have been proposed in the pathogenesis of TCS and ocular disease, namely via systemic absorption and secondly through seepage over the eyelid or absorption by the eyeball through the palpebral fissure. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] The main questions arising from this search include: (i) can the periorbital application of topical steroids induce glaucoma and cataracts and, if so, what quantities are required; (ii) are individuals with known ocular disease at risk of exacerbating their condition by using TCS and (iii) can topical steroids applied on other areas of the body lead to ocular complications? 9 Glaucoma may be caused by direct contact of the TCS with the conjunctiva or through the eyelids.…”

Section: Introductionmentioning

confidence: 99%

Ocular side–effects of topical corticosteroids: what a dermatologist needs to know

Daniel

Orchard

2015

Aust J Dermatology

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Topical corticosteroids are used frequently in dermatology and atopic dermatitis without significant adverse effects. Though ocular diseases such as glaucoma and cataracts are known complications of systemic corticosteroids, the role of topical corticosteroids is limited to case reports. This review assesses the literature regarding topical steroids and their role in ocular diseases. There is evidence of harm to vision when potent topical corticosteroids are inappropriately used for prolonged periods to periorbital sites. There is no evidence to date that weak TCS to the face or potent TCS to areas other than the eyes results in ocular complications. Further research trials are required in this area.

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“…Here the medications given to an individual with pre-existing Flammer syndrome and normal tension glaucoma produced the so dreaded outcome of visual loss. On the contrary, to our knowledge, a betamethasone-vascular dysregulation interaction (patient 3) has not been reported so far [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome

et al. 2015

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BackgroundA variety of factors have been linked to perioperative visual loss during or directly after nonocular and ocular surgeries. Prolonged immobilization, biochemical factors and hemodynamic instability have been discussed as factors in the pathogenesis of this devastating complication. Perioperative visual loss in four consecutive patients, all featuring Flammer syndrome, is reported herein. To our knowledge, we present the first case series, which associates perioperative visual loss with Flammer syndrome. We assume that a low perfusion pressure, disturbed autoregulation of the ocular blood flow and altered drug sensitivity in such subjects, play significant role in the pathogenesis of this dreaded complication.Cases presentationWe analysed the medical records of four consecutive patients with permanent perioperative visual loss and complemented our findings with additional history taking and clinical examinations. A variety of tests was performed, including colour Doppler ultrasonography of the retroocular vessels, static and dynamic retinal vessel analysis. The visual loss was unilateral in three patients and bilateral in one. An extensive review of published perioperative vision loss cases was conducted.All four patients were male Caucasians, and exhibited prominent signs and symptoms of Flammer syndrome. The visual loss originated from a propensity for unstable ocular blood flow, combined with hyperreactivity toward pharmacological stimuli, leading together to disturbed autoregulation of the blood supply, and subsequently - to ocular hypoxia. An identified intrinsic hypoperfusion diathesis was a crucial pathophysiologic link in all of the patients. Other, yet unknown systemic or local factors may also be involved in this process.ConclusionsA review of numerous publications of perioperative visual loss and our data, support our hypothesis for a novel pathophysiologic model and incorporate Flammer syndrome as a distinct risk factor for paradoxical visual loss, during nonocular and ocular surgeries, or invasive procedures. To prevent the complications produced by disturbed blood flow autoregulation in such patients, guidelines for screening and tailored preoperative approach are given.

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Irreversible visual loss secondary to excessive topical steroid use in eczema

Cited by 6 publications

References 6 publications

Associations between factors related to atopic disease and glaucoma in the National Health and Nutrition Examination Survey

Associations between factors related to atopic disease and glaucoma in the National Health and Nutrition Examination Survey

Ocular side–effects of topical corticosteroids: what a dermatologist needs to know

The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome

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