The eyes have it.

October 26, 2008 4:30 AM

How concerned about glaucoma should I be?

I have chronic ezcema on my eyelids and right at the inner and outer corners of the eye.

I've had this since I was about 6 (following a case of pink eye, actually) and have treated it, since I was 6 with Elocon (0.1% mometasone furoate) ointment.

Now, this flares up about once or twice a month at the very most, and I apply a very thin layer of Elocon to the eyelids and the inner portions. (If I don't, the skin gets red and then constantly burns, and begins to crust and this pain on your eyelids is, I assure you, no party.)

Doctors have always warned to only use Elocon reactively, never proactively, since it's a steroid and "could thin the skin." *Just* what you want to hear when using medicine on the thinnest skin on the body. And the specific section that keeps LIGHT out.

Now I've found that the side effects can also include glaucoma. "But only if applied directly to the eye." Well, shit. I've gotten elocon in my eye so many times it's ridiculous. Again, exceedingly small quantities and not terribly often. But still; when I apply into the corners, it inevitably makes its way into the eye itself. (And burns like an unholy bitch.)

I was tested for glaucoma at my latest eye exam and will make sure that I let my optometrist know I'm technically an elevated risk for it, but my issue is that I *cannot* find any additional data on exposure and causality. "May worsen OR cause" is ridiculously vague, because it's probably one of those contraindications that you just gloss over because, you know, who would put this in their EYE?

Clearly, I'm as careful as I can be. I've also tried non-steroidal options like Elidel. They fail miserably and provide no relief.

So what are we likely talking, here? Lab rats having kilos dumping into their eyes? Or regular, long-term-if-not-terribly-often usage like mine, with just enough exposure to really push me over the edge?

Can I find more detail about the link? Googling just brings the warning, no additional sources or information are available anywhere...

Thanks!

posted by disillusioned to health & fitness (4 comments total)

Glaucoma is highly treatable and will not give you any symptoms or nerve damage if it is detected early enough. Therefore, definitely continue to get regular (probably annual is sufficient) glaucoma tests. I'm afraid I don't know the name of the way they measure my eye pressure, but be sure to have them use the one that seems like they are putting a blue light in your eye, NOT the puffs of air in your eye since that one is very innacurate.
posted by tallus at 6:39 AM on October 26, 2008

Here's a recent review of the current state of the literature on steroid-induced glaucoma. Essentially (and bear in mind that I have no actual qualifications for understanding this sort of thing), there's no hard data on exactly how much of a risk steroids pose for the development of glaucoma, but it seems to be pretty rare and your use is about a low risk as it gets. It's not as if you're even directly applying it to your eye.

So it's something to be aware of, but I think it's unlikely to be anything you need to actively worry about. The authors recommend monthly follow-ups for infrequent users of topical steroids, but this presumably refers to people who are intentionally applying corticosteroids to their eyes and have some kind of eye disease requiring care by an ophthalmologist.
posted by xchmp at 7:46 AM on October 26, 2008

I have no hard data, but I do have anecdotal data:

I have an occasional recurring condition that requires me to take steroid eye drops. This is a chronic health problem, and when I have it (about every 18-24 months), I take the drops for several weeks in whichever eye is affected. I start off by taking them 1x hour and, when the doctor permits, taper off to 1x day before discontinuing use. I've been told to use steroid drops proactively if I'm concerned about the condition coming on. I've had this condition since 1994.

My doctors test me regularly for pressure and have discussed the existence of the glaucoma risk, but they don't seem concerned about the risks. I've never had significantly elevated pressure, even when I take the drops on an hourly basis (and I'm in every day or two at that phase). I do follow-ups every six months and I always get my pressure checked.

Hope this helps.
posted by immlass at 9:06 AM on October 26, 2008

tallus: It's called a Goldmann tonometer.
posted by AstroGuy at 11:20 AM on October 27, 2008