The hidden ophthalmic dangers of steroids in COVID-19 treatment: a case report

Coronavirus disease 2019 (COVID-19) has been coexisted with us, and corticosteroids are now recommended for patients with severe COVID-19 respiratory failure. Steroid treatments may increase intraocular pressure (IOP) and steroid-induced glaucoma (SIG). This study reported a rapid IOP elevation in a COVID-19 pneumonia child treated with systemic steroids within 3 days. Steroid-induced ocular hypertension (SIOH) during pneumonia treatment has not been previously reported.

The 6-year-old Chinese girl was diagnosed with COVID-19 and presented with pulmonary exudative lesions. Intravenous steroid (methylprednisolone, 1 mg/kg/12 h) was administered to control the inflammatory reaction on the fourth day post-infection. The child complained of ocular pain in the left eye (OS) after 3 days of steroid application. A high IOP of 40 mmHg in the right eye (OD) and 60 mmHg (OS) was detected. Following the exclusion of elevated IOP secondary to COVID-19 infection, SIOH was considered as a potential etiology. The IOP was effectively controlled through prompt tapering of systemic steroids and the immediate initiation of IOP-lowering therapy, including intravenous mannitol and topical antiglaucoma medications.

Clinicians treating COVID-19 in hospitals should pay attention to SIOH or SIG risk, especially in pediatric patients.