title: Transient glaucoma after an epidural steroid injection: a case report.
abstract: BACKGROUND
  Steroids are recognized as a beneficial treatment for various medical conditions, yet clinically relevant side effects of steroids are common and problematic, ranging from a minor case of acne to a potentially life-threatening Addisonian crisis. In anesthetic medicine, the use of epidural steroid injections (ESIs) for chronic low back pain and other radicular pain-related conditions has become standard practice in interventional pain management.
  
  
  METHODS
  We report the case of a patient who experienced sudden bilateral blurred vision after receiving an ESI and required urgent ophthalmic interventions and follow-up care. The main clinical findings from this case showed that the patient had high intraocular pressure (IOP) that caused unexpected short-term vision loss. The symptom resolved after 3½ months without ophthalmic treatment.
  
  
  CONCLUSIONS
  Clinicians should inform patients about the possibility of visual complications associated with pain procedures involving steroids. Among the high-risk groups with predisposing factors, such as uncontrolled hypertension and diabetes mellitus, routine eye tests that include measuring IOP prior to ESI should be recommended as a preventive measure. Alternative pain management therapies should be considered if possible. Comprehensive planning of patient care will also ensure safety and prevent unwanted outcomes, particularly with high-risk patients receiving steroids for pain procedures.
authors.affiliation: Department of Pain Medicine, Epsom and St. Helier University Hospitals National Health Service Trust, Epsom, United Kingdom.
authors.forename: Deepak
authors.initials: D
authors.lastname: Manjiani
authors.affiliation: Department of Pain Medicine, Epsom and St. Helier University Hospitals National Health Service Trust, Epsom, United Kingdom.
authors.forename: Salam
authors.initials: S
authors.lastname: Said
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA ; Department of Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
keywords: Glaucoma–open angle; injections–epidural; intraocular pressure; steroids; vision disorders
references.citation: Pain Physician. 2007 Jan;10(1):185-212
references.pmid: 17256030
references.citation: Eur Spine J. 2010 Sep;19(9):1425-49
references.pmid: 20424870
references.citation: Ochsner J. 2014 Summer;14(2):203-7
references.pmid: 24940130
references.citation: Pain Physician. 2012 Nov-Dec;15(6):461-6
references.pmid: 23159961
references.citation: Ophthalmology. 2008 Apr;115(4):667-72
references.pmid: 17716733
references.citation: Ophthalmic Res. 2012;47(2):66-80
references.pmid: 21757964
references.citation: J Cataract Refract Surg. 1998 May;24(5):715-8
references.pmid: 9610459
references.citation: AANA J. 2007 Jun;75(3):183-8
references.pmid: 17591298
references.citation: Int Ophthalmol Clin. 1993 Spring;33(2):135-9
references.pmid: 8325728
references.citation: Pain Physician. 2012 May-Jun;15(3):E159-98
references.pmid: 22622911
references.citation: Pain Physician. 2007 Sep;10(5):697-705
references.pmid: 17876368
references.citation: Eye (Lond). 2011 Aug;25(8):971-80
references.pmid: 21637303
references.citation: J Anaesthesiol Clin Pharmacol. 2012 Jan;28(1):11-6
references.pmid: 22345938
references.citation: Lancet. 2004 May 22;363(9422):1711-20
references.pmid: 15158634
references.citation: Am Fam Physician. 2003 May 1;67(9):1937-44
references.pmid: 12751655
references.citation: Pain Physician. 2002 Apr;5(2):182-99
references.pmid: 16902669