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Case Report: Steroid-induced Ocular Hypertension in a 6-year-old Boy
Insights
Pediatric systemic corticosteroid use can cause rapid, severe ocular hypertension. Early intraocular pressure monitoring is crucial for children on these medications to prevent vision loss.
Area of Science:
- Pediatric Ophthalmology
- Ocular Pharmacology
- Systemic Corticosteroid Therapy
Background:
- Systemic corticosteroid use in children is uncommon due to adverse effects.
- The rise of multisystem inflammatory syndrome associated with COVID-19 may increase pediatric corticosteroid use.
Observation:
- A 6-year-old boy on systemic dexamethasone for leukemia developed severe ocular hypertension (65 mmHg).
- Headaches were the presenting symptom of elevated intraocular pressure.
Findings:
- Prompt treatment with maximum topical glaucoma therapy normalized intraocular pressure.
- This resolved the patient's headache symptom.
Implications:
- Eye care providers must monitor intraocular pressure in pediatric patients receiving systemic corticosteroids.
- Increased vigilance is needed due to potential rises in corticosteroid use during the COVID-19 pandemic.
- Early detection and management can prevent irreversible vision loss.
Significance:
Systemic corticosteroid use in children is rare because of known risks of adverse effects. The increased prevalence of multisystem inflammatory syndrome associated with COVID-19 may change this. It is critical for eye care providers to be aware of potential severe and rapid ocular hypertensive response to prevent irreversible vision loss.
Purpose:
The purpose of this study was to report the importance of early monitoring of intraocular eye pressure in pediatric patients on systemic steroid medication.
Case Report:
A 6-year-old White boy presented with a complaint of headache for 2 weeks. He was on his 19th day of treatment for acute lymphoblastic leukemia with oral dexamethasone and chemotherapy. IOP at presentation was 65 mmHg in both eyes measured with iCare tonometry. Treatment with maximum topical glaucoma therapy reduced IOP to normal levels and eliminated the symptom of headache.
Conclusions:
This case reminds eye care providers to be aware of the potential ocular hypertensive response to systemic steroid treatment and the importance of establishing early monitoring. With the emergence of multisystem inflammatory syndrome in children during the current COVID-19 pandemic, eye care providers may encounter more pediatric patients on systemic corticosteroid treatment than previously and should adjust their examinations appropriately.
