Can I take steroids if I have glaucoma? Understanding the Risks and Alternatives

October 12, 2025 •

3 min read

According to the Glaucoma Research Foundation, up to 90% of patients with open-angle glaucoma may experience a rise in intraocular pressure when exposed to steroids. This fact raises a critical question for many patients: Can I take steroids if I have glaucoma? The answer is complex, as corticosteroids can pose a significant risk to eye health by increasing pressure, but for some conditions, they are medically necessary.

Quick Summary

Corticosteroids in various forms can significantly increase intraocular pressure, potentially worsening glaucoma and causing irreversible optic nerve damage. This risk is higher for those with open-angle glaucoma. The use of steroids requires careful medical monitoring and should only be undertaken after thorough consultation with an ophthalmologist to explore alternatives and mitigation strategies.

Key Points

Steroids can raise eye pressure: All types of corticosteroids—oral, inhaled, injected, and topical—can increase intraocular pressure in susceptible individuals.
Open-angle glaucoma is particularly vulnerable: Individuals with open-angle glaucoma or a family history of it are highly susceptible to steroid-induced pressure spikes.
IOP elevation can be asymptomatic: The rise in eye pressure often has no noticeable symptoms in early stages, making regular monitoring by an ophthalmologist critical.
Risk depends on potency and duration: More potent steroids and longer treatment courses carry a higher risk of raising eye pressure.
Less-potent alternatives exist: For some inflammatory conditions, switching to a less-potent steroid (e.g., loteprednol) or a non-steroidal anti-inflammatory drug (NSAID) can minimize the risk.
Reversal is often possible: In most cases, stopping the steroid can normalize eye pressure, but early intervention is crucial to preventing irreversible optic nerve damage.
Communicate with your doctor: Always inform all prescribing physicians and your ophthalmologist about your glaucoma diagnosis and any steroid use to ensure safe, coordinated care.

The Critical Connection Between Steroids and Glaucoma

Glaucoma is a group of eye diseases characterized by damage to the optic nerve, often caused by abnormally high pressure inside the eye (intraocular pressure or IOP). Corticosteroids, commonly known as steroids, are a class of medications used to treat a wide range of inflammatory and autoimmune conditions. While effective for their intended purpose, these powerful drugs are also known to cause an increase in IOP in susceptible individuals.

This steroid-induced rise in IOP is a major concern for anyone with a pre-existing glaucoma diagnosis, as it can accelerate optic nerve damage and vision loss. All forms of corticosteroid administration—topical eye drops, inhalers, nasal sprays, oral pills, and injections—can lead to elevated eye pressure, though the risk and magnitude vary depending on the route and dosage. Patients with glaucoma, particularly those with open-angle glaucoma, must approach steroid use with extreme caution and under strict medical supervision.

The Mechanism of Steroid-Induced IOP Elevation

Steroids primarily raise intraocular pressure by affecting the trabecular meshwork, the eye's natural drainage system. This process involves structural and biochemical changes within the trabecular meshwork cells, leading to an accumulation of proteins and debris in the outflow channels. This obstruction increases the resistance to the outflow of aqueous humor, the fluid in the eye, causing IOP to rise.

Factors Influencing Steroid-Induced Glaucoma

For information on the factors influencing steroid-induced glaucoma and a comparison of different steroids and risk levels, please refer to {Link: EyeWorld https://www.eyeworld.org/2025/identifying-and-handling-steroid-induced-glaucoma/}. The management strategy for requiring steroid treatment while having glaucoma often involves several key steps:

1. Close Monitoring

Your ophthalmologist will need to monitor your IOP frequently, particularly when starting a new steroid regimen. Regular eye exams are crucial for detecting pressure changes before damage occurs.

2. Discontinuation of Steroid Therapy

The most effective treatment for steroid-induced IOP increase is often to stop or taper the steroid use if medically possible. Pressure can normalize within days or weeks for acute responses, but may take longer or be incomplete after prolonged use.

3. Alternative Medications

When appropriate, your doctor may suggest non-steroidal alternatives:

Non-steroidal anti-inflammatory drugs (NSAIDs): Topical NSAID eye drops can be used for some ocular inflammation.
Less-potent steroids: Switching to a less-potent corticosteroid may minimize the risk of a significant IOP spike.
Steroid-sparing agents: Immunosuppressants can sometimes reduce or eliminate the need for steroids for systemic conditions.

4. Glaucoma Medication Adjustment

If steroids are essential, additional glaucoma medications may be prescribed to counteract their pressure-increasing effects. These can include prostaglandin analogs, beta-blockers, or carbonic anhydrase inhibitors.

5. Surgical Intervention

In rare cases of persistent, uncontrolled steroid-induced glaucoma, surgery like trabeculectomy may be needed to improve fluid drainage.

What to Discuss with Your Healthcare Providers

Before starting any steroid treatment, discuss your glaucoma diagnosis with both your prescribing physician and your ophthalmologist. Key points to cover include:

Inform all medical providers about your glaucoma and any other eye conditions.
Discuss your specific type of glaucoma, as risks vary.
Review the planned steroid details: dosage, duration, and administration route.
Ask about the lowest effective dose and if less-potent options are suitable.
Inquire about non-steroidal alternatives.
Confirm a monitoring schedule with your ophthalmologist to track IOP.

Conclusion: Navigating Steroid Use with Caution

Corticosteroids are essential medications for many conditions, but they pose a significant risk of increasing intraocular pressure and potentially causing irreversible optic nerve damage in individuals with glaucoma. Safe management requires a coordinated approach involving open communication with your medical team, exploring alternative treatments when possible, using the lowest effective steroid dose for the shortest necessary duration, and consistent IOP monitoring. By working closely with your ophthalmologist and other doctors, you can make informed decisions to protect your vision while managing other health conditions that require steroid therapy. {Link: EyeWorld https://www.eyeworld.org/2025/identifying-and-handling-steroid-induced-glaucoma/}

Frequently Asked Questions

Steroid-induced glaucoma is a form of secondary open-angle glaucoma where intraocular pressure (IOP) increases as an adverse effect of corticosteroid therapy. The steroid alters the eye's drainage system, causing fluid to build up and pressure to rise, which can damage the optic nerve if left unchecked.

Yes, but with caution. Steroid creams, particularly those used on the face or eyelids, can be absorbed and increase intraocular pressure. It is important to wash your hands thoroughly after application and avoid touching your eyes. Regular eye pressure checks are recommended for anyone on chronic or high-potency facial steroids.

Steroid inhalers, used for conditions like asthma, can increase IOP, though generally less so than eye drops. If you have glaucoma, your ophthalmologist should monitor your eye pressure if you are using an inhaled steroid, especially over a long period.

With topical steroid eye drops, an increase in intraocular pressure typically occurs within 3 to 6 weeks of starting treatment. However, some susceptible individuals, especially those with pre-existing glaucoma, may show an earlier and more significant pressure spike.

Depending on the condition, alternatives may include non-steroidal anti-inflammatory drugs (NSAIDs) for eye inflammation or steroid-sparing immunosuppressant medications for systemic autoimmune diseases. Always discuss and evaluate these options with your doctor.

You should inform your doctor immediately that you have glaucoma. Your healthcare provider will then coordinate with your ophthalmologist to determine the safest possible dose, duration, and route of steroid administration, while ensuring your eye pressure is closely monitored.

In most cases, elevated eye pressure from steroid use returns to normal within a few weeks of stopping the medication. However, in some individuals, particularly after long-term use, the pressure may remain elevated, and treatment for glaucoma may still be necessary.