Severe acute ocular hypertension following pulsed methylprednisolone for juvenile idiopathic arthritis

Area of Science:

• Ophthalmology
• Pediatrics
• Rheumatology

Background:

• Juvenile idiopathic arthritis (JIA) is a common rheumatic disease in children.
• Anterior uveitis is a frequent ocular complication of JIA.
• Systemic corticosteroids are used to manage JIA flares and associated inflammation.

Observation:

• A 6-year-old girl with JIA and anterior uveitis received intravenous methylprednisolone for acute arthritis.
• Following treatment, she experienced severe ocular hypertension, with intraocular pressures (IOPs) reaching 54 mm Hg in the right eye and 61 mm Hg in the left eye.
• Normal IOP ranges between 12-22 mm Hg.

Findings:

• Intravenous methylprednisolone therapy led to acute, severe ocular hypertension in a pediatric patient.
• The elevated IOP required inpatient treatment with intravenous acetazolamide.
• This case demonstrates a significant adverse effect of systemic steroid administration.

Implications:

• Pediatric patients receiving high-dose systemic or topical steroids, especially those with risk factors, require vigilant IOP monitoring.
• Early detection and management of steroid-induced ocular hypertension are essential to prevent vision-threatening complications.
• Ophthalmologists and pediatric rheumatologists should be aware of this potential complication in managing JIA.