TITLE:
Glaucomatous Damage Secondary to Long Term Topical Corticosteroid Use in a 7-Year-Old Female
AUTHORS:
Michael Greenwood, Florin Grigorian
KEYWORDS:
Glaucoma; Corticosteroids; Atopic Dermatitis
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.4 No.1,
March
14,
2014
ABSTRACT:
Introduction: Topical
corticosteroids are commonly prescribed for children with atopic dermatitis.
Although generally well tolerated, long term unsupervised use can lead to
ocular damage, including glaucoma. Much of the current literature focuses on
the periorbital use in older patients. We present a case of an adolescent who
suffered glaucomatous damage secondary to long term topical steroid use on her
extremities. Methods: This is a case report of a child with extensive work-up
for glaucoma suspect. Results: A 7-year-old African American female was found
to have glaucomatous damage after using 2.5% hydrocortisone cream on her arms,
legs, and back of neck twice daily continuously for 2 years. There were no
other mechanisms that could have produced a secondary glaucoma. Congenital
anomalous disk is a remote possibility. Discussion: Steroid cream use for
atopic dermatitis is relatively common. The side effect profile of topical
corticosteroids has been well documented and includes glaucoma. These patients
may not have any visual symptoms, and can present at an advanced stage, with
irreversible vision loss. Children with atopic dermatitis are especially
susceptible to the systemic effects of steroids because of the damaged
epithelial layer and also the body surface area to volume, both of which
increase the bioavailability of the medication. Conclusion: Because topical
steroids are commonly used, especially in children, patients need to be aware
of the potentially dangerous side effects, including vision loss from glaucoma.