title: Steroid-induced glaucoma and childhood blindness.
abstract: OBJECTIVE
  To determine the prevalence, risk factors and the severity of visual loss caused by steroid-induced glaucoma (SIG) among children.
  
  
  METHODS
  Five-year records of all paediatric glaucoma cases presenting to the glaucoma services of our tertiary care centre were evaluated. Data of children presenting with SIG were recorded with respect to their visual acuity, highest baseline intraocular pressure, cup:disc ratio, perimetry and need of glaucoma filtering surgery. Parents were interviewed to assess the indication of steroid use, type of steroid used, person prescribing it and the duration of use. The prevalence of visual impairment was calculated based on WHO criteria.
  
  
  RESULTS
  Of 1259 cases of paediatric glaucoma presenting at our centre over 5 years, 59 children (4.7%) were diagnosed with SIG. Of these, 51 (87%) had been prescribed topical steroids for vernal keratoconjunctivitis (VKC). The median duration of steroid use was 18 months (range 1 month to 8 years). Also, 82% of children with VKC had been prescribed steroids by the treating ophthalmologist and 52% had been on topical steroids for >1 year. Glaucomatous optic neuropathy was the cause of blindness in 37.3% (22/59) and low vision in 23.7% (14/59) children. And 27% (16/59) were unilaterally blind at presentation.
  
  
  CONCLUSIONS
  A third of the children presenting with SIG to our tertiary care centre were bilaterally blind at presentation. Ophthalmologists need to consider steroid-sparing agents to treat VKC and monitor these children closely for glaucoma if they prescribe topical steroids in order to prevent unnecessary childhood blindness.
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shikha
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Shah
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sartaj
authors.initials: S
authors.lastname: Grewal
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Abadh Kishore
authors.initials: AK
authors.lastname: Chaurasia
authors.affiliation: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Viney
authors.initials: V
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D001766:Blindness / Q000139:chemically induced / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003233:Conjunctivitis, Allergic / Q000188:drug therapy; D005260:Female; D005901:Glaucoma / Q000139:chemically induced / Q000453:epidemiology*; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007194:India / Q000453:epidemiology; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015354:Vision, Low / Q000139:chemically induced / Q000453:epidemiology*; D014792:Visual Acuity / Q000187:drug effects; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data
chemical_list: D005938:Glucocorticoids
keywords: Field of vision; Glaucoma; Intraocular pressure; Optic Nerve; Vision