Retrospective study on periocular steroid ointment use and its effect on intraocular pressure

Abstract

Purpose : Topical steroid intraocular drops and systemic steroid medications (oral and intravenous) have been extensively shown to play a role in intraocular pressure (IOP) elevation. Several case reports have linked long-term steroid ointment use to IOP elevation and glaucoma; however, no formal analyses have been performed. This retrospective chart review aims to investigate short-tem periocular steroid ointment use and IOP.

Methods : The charts of all patients aged 18 and older with the diagnosis of atopic dermatitis or eczema treated with periocular steroid ointment from January 1^st, 2007 to October 1^st, 2017 at the Edward S. Harkness Eye Institute were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data was collected regarding gender, treatment regimen, duration of treatment, as well as IOP prior to and during treatment. Steroid responders were identified based on the Armaly classification. Statistical analysis was performed with paired t-test models.

Results : Thirty-two records were reviewed with 54 total treatment eyes. Twenty-two patients were treated bilaterally, 8 patients in the right eyelid only, and 2 patients in the left eyelid only. Five patients were diagnosed as normal-tension primary open angle glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1 to 83.9 weeks. Fluorometholone, loteprednol etabonate, and dexamethasone-neomycin-polymyxin B were the treatments of choice. The mean IOP change was 0.2 OD and -0.1 OS; no statistically significant change in IOP during treatment with periocular steroid was found (p-value: 0.3 OD, 0.4 OS). Based on the Armaly classification, individual steroid responses included: 1 intermediate and 31 low responders, of which 19 patients had an IOP change less than 1 mmHg. One out of the five patients labeled as a glaucoma suspect had an intermediate steroid response of 7 mmHg.

Conclusions : Periocular steroid treatment use may have an effect on IOP. However, a statistically significant change was not found in this limited retrospective review. A large-scale controlled, prospective trial may need to be conducted to further elucidate this relationship.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.