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Severe ocular hypertension secondary to systemic corticosteroid treatment in a child with nephrotic syndrome

Pedro Nuno Brito1, Sérgio Estrela Silva, José Silva Cotta

  • 1Ophthalmology Department, Hospital S João, Porto, Portugal.

Clinical Ophthalmology (Auckland, N.Z.)
|October 26, 2012
PubMed

Insights

Oral steroid treatment can cause severe, acute ocular hypertension in children. Regular eye exams during steroid therapy are crucial to prevent vision loss.

Area of Science:

  • Ophthalmology
  • Pediatrics
  • Endocrinology

Background:

  • Nephrotic syndrome is a common kidney disorder in children.
  • Systemic corticosteroids, such as prednisolone, are a primary treatment for nephrotic syndrome.
  • Corticosteroid therapy can have various side effects, including ocular complications.

Observation:

  • A 6-year-old child with nephrotic syndrome developed severe ocular hypertension (intraocular pressure >50 mmHg) seven days after starting oral prednisolone.
  • Symptoms included headache, vomiting, ocular pain, and photophobia.
  • Ultrasound biomicroscopy showed an open angle, and perimetry revealed normal visual fields.

Findings:

  • Prompt treatment with topical antiglaucoma medications (latanoprost, brimonidine, timolol/dorzolamide) effectively lowered intraocular pressure.
  • As corticosteroid dosage was reduced, antiglaucoma medication was tapered while maintaining controlled intraocular pressure.
  • Four months post-treatment, intraocular pressure normalized without medication, and optical coherence tomography showed normal retinal nerve fiber layer thickness.

Implications:

  • Systemic corticosteroids can induce acute, severe ocular hypertension in pediatric patients.
  • Routine ophthalmologic examinations are essential for children on systemic steroid therapy.
  • Early intervention with antiglaucoma treatment can prevent permanent visual damage, including retinal nerve fiber layer loss.
Abstract

Keywords:
childrencorticosteroidglaucomanephrotic

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