What Eye Condition Is Caused by Steroids?: A Comprehensive Guide to Glaucoma, Cataracts, and More

According to studies, over 30% of individuals can experience a moderate rise in intraocular pressure (IOP) after using topical steroids. This steroid response can lead to serious eye complications, with the most significant being glaucoma and cataracts, making it crucial for patients to understand what eye condition is caused by steroids and the associated risks.

Quick Summary

Long-term steroid use, via various routes, can cause serious eye complications like glaucoma, cataracts, and central serous retinopathy. Risks increase with higher doses and longer durations, necessitating regular ophthalmological monitoring.

Key Points

• Steroid-Induced Glaucoma: Long-term use of corticosteroids can lead to elevated intraocular pressure (IOP) by increasing resistance to fluid outflow in the eye's drainage system.

• Posterior Subcapsular Cataracts: Steroid use is strongly associated with the formation of cataracts on the back surface of the eye's lens, which can cause glare and blurry vision.

• Central Serous Retinopathy: Steroids can trigger a buildup of fluid under the retina, causing central visual distortion and blurred vision.

• Routes of Administration Matter: Ocular steroid risks are highest with topical drops and injections, but oral, inhaled, and nasal steroids also carry a risk, especially with long-term use.

• Regular Monitoring is Crucial: Because early stages are often asymptomatic, regular eye exams are essential for individuals on long-term steroid therapy to detect issues like rising IOP.

• Management Involves Stopping Steroids: The primary treatment for steroid-induced glaucoma is discontinuing the steroid, while cataracts require surgical intervention.

• Individual Susceptibility: Some people, particularly those with a family history of glaucoma or diabetes, are more prone to developing ocular complications from steroid use.

Ocular Complications of Steroid Therapy

Steroids, or corticosteroids, are a powerful class of drugs used to treat a wide array of inflammatory and autoimmune conditions, from allergic conjunctivitis to asthma and rheumatoid arthritis. While highly effective, their use is not without risks, especially when administered long-term or in high doses. The eye is particularly susceptible to adverse effects, and a clear understanding of potential complications is essential for both patients and healthcare providers. The most significant ocular conditions linked to steroid use are glaucoma and cataracts, but other issues, such as central serous retinopathy, can also occur. Awareness and proactive management are key to preventing permanent vision loss.

The Primary Culprits: Glaucoma and Cataracts

Steroid-Induced Glaucoma

Steroid-induced glaucoma is a type of secondary open-angle glaucoma caused by elevated intraocular pressure (IOP). This silent condition is often asymptomatic in its early stages, meaning patients may not notice vision loss until significant, irreversible damage has occurred to the optic nerve.

Mechanism: The primary cause of elevated IOP is increased resistance to the outflow of aqueous humor, the clear fluid that fills the front of the eye. Steroids affect the trabecular meshwork (TM), the tissue responsible for draining this fluid. They cause biochemical and morphological changes, leading to an accumulation of extracellular matrix proteins and debris within the TM. This effectively clogs the drainage system, causing fluid to back up and pressure to build. In most cases, this process is reversible upon discontinuation of the steroid, but in some instances, the damage can become permanent.

Risk Factors: Certain individuals are more susceptible to steroid-induced IOP elevation, known as 'steroid responders.' Risk factors include:

• A pre-existing diagnosis of primary open-angle glaucoma (POAG) or a family history of POAG.
• A history of previous steroid-induced IOP elevation.
• Type 1 diabetes mellitus.
• High myopia (nearsightedness).
• Being very young (under six years old) or older.
• Having a connective tissue disease, such as rheumatoid arthritis.
• Undergoing penetrating keratoplasty (corneal transplant).

Steroid-Induced Cataracts

Another common and widely recognized side effect of corticosteroid use is the formation of cataracts. Specifically, steroids are linked to the development of posterior subcapsular cataracts (PSCs). PSCs form near the back of the lens, creating cloudy, opaque patches that obstruct light from reaching the retina.

Mechanism: The exact mechanism is not fully understood but is believed to involve the disruption of normal lens metabolism. Glucocorticoids can alter gene transcription in lens epithelial cells, leading to cellular changes and protein aggregation that results in the lens becoming cloudy. Unlike steroid-induced glaucoma, cataract formation is not reversible by simply stopping the medication. If the cataract interferes with daily life, surgery is required.

Symptoms: Patients with PSCs often report specific visual disturbances, such as:

• Glare or halos around lights, particularly at night.
• Difficulty reading fine print.
• Worsened vision in bright, sunny conditions.
• Blurred or double vision.
• Colors appearing less vivid.

Beyond Glaucoma and Cataracts: Other Eye Complications

While glaucoma and cataracts are the most common, steroids can cause other serious eye conditions.

Central Serous Retinopathy (CSR)

Central serous retinopathy is a condition characterized by a fluid buildup under the retina, which can lead to a small retinal detachment. Steroid use, in any form, is the most common trigger for CSR. Symptoms can include:

• Blurred or dim vision in one or both eyes.
• Dark spots in the central field of vision.
• Distorted vision, making straight lines appear wavy.
• Objects appearing smaller or farther away.

CSR sometimes resolves on its own, but persistent or severe cases may require treatment with laser surgery or photodynamic therapy.

Other Potential Issues

Extended steroid use can also lead to other problems, including:

• Delayed Wound Healing: Steroids can impair the body's natural healing process, which is particularly relevant after eye surgery.
• Secondary Infections: By suppressing the immune system, steroids can increase the risk of bacterial, viral, or fungal infections in the eye.

Steroid Administration Routes and Ocular Risk

The risk of developing an eye condition from steroid use varies depending on the method of administration. Higher doses and longer durations are generally associated with a greater risk.

Administration Route	Relative Ocular Risk	Common Uses	Risk Profile
Topical (Eye Drops)	Highest	Uveitis, post-surgical inflammation	High risk of IOP elevation, especially with potent agents like prednisolone and dexamethasone, and posterior subcapsular cataract (PSC) formation.
Intraocular (Injections)	High	Macular edema, diabetic retinopathy	Can cause significant IOP spikes, with a potentially delayed peak effect compared to topical drops.
Periocular (Injections)	Intermediate	Uveitis, macular edema	Risk of IOP elevation is greater than with topical drops but less than intraocular injections.
Oral (Pills/Liquid)	Intermediate	Autoimmune diseases, severe inflammation	Can cause both cataracts and glaucoma, particularly with long-term use.
Inhaled/Nasal Sprays	Low to Moderate	Asthma, allergies	Still carries a risk, especially with higher cumulative doses over a long duration.
Topical (Skin Creams)	Low	Dermatologic conditions	The lowest risk, though systemic absorption and eye contact can still occur.

Diagnosis and Management

Early detection and careful management are vital for mitigating the risks associated with steroid-induced eye conditions. For any patient on long-term corticosteroid therapy, especially topical or oral, regular comprehensive eye exams with an ophthalmologist are mandatory.

Diagnosis:

• Intraocular Pressure (IOP) Measurement: The eye doctor will use a tonometer to measure IOP, looking for any abnormal elevations.
• Slit-Lamp Examination: This allows the doctor to examine the lens for signs of cataract formation and assess the anterior segment of the eye.
• Funduscopy: The optic nerve and retina are examined for signs of glaucomatous damage or fluid buildup (CSR).

Management:

• Discontinue or Taper Steroids: The first and most effective step is to stop or significantly reduce the steroid use, if medically feasible. In many cases, this resolves the ocular hypertension.
• Medications: If steroids cannot be stopped or if pressure remains elevated, the condition is treated similarly to other forms of glaucoma. This often involves topical eye drops like beta-blockers or prostaglandin analogs. Steroid-sparing anti-inflammatory agents may also be considered.
• Laser Therapy: Laser trabeculoplasty can be used to improve aqueous outflow in some cases of steroid-induced glaucoma that do not respond to medication.
• Surgery: For advanced cases of steroid-induced glaucoma or if a patient requires continued steroid therapy, surgical options like a trabeculectomy may be necessary.
• Cataract Surgery: Once vision is significantly impacted by steroid-induced cataracts, the only definitive treatment is surgical removal of the cloudy lens and replacement with an artificial intraocular lens.

Conclusion

While steroids are indispensable medications for many inflammatory conditions, their potential side effects on the eyes must be taken seriously. The most common and vision-threatening ocular complications are steroid-induced glaucoma and cataracts, which are heavily influenced by the steroid's potency, dose, and duration of use. Proactive and consistent communication with your healthcare and eye care providers is essential. By understanding the risks, undergoing regular monitoring, and promptly addressing any issues, patients can benefit from necessary steroid therapy while minimizing the threat to their vision. For more information, the American Academy of Ophthalmology offers valuable resources on managing steroid-induced glaucoma.

References

• Feroze, K. B., Zeppieri, M., & Khazaeni, L. (2023). Steroid-Induced Glaucoma. In StatPearls. StatPearls Publishing. Link.
• Houston Rheumatology. (2022). 5 Prednisone Side Effects That You Should Know. Link.
• GoodRx. (2025). Central Serous Retinopathy: Causes, Symptoms, and Treatment. Link.
• EyeWiki. (2025). Ocular Manifestations of Corticosteroids. Link.
• Glaucoma Today. (2024). Steroid Therapy and IOP. Link.
• Medscape. (2024). Drug-Induced Glaucoma. Link.
• EyeWiki. (2023). Steroid-Induced Glaucoma. Link.
• American Academy of Ophthalmology. (2021). Characteristics and Management of Steroid-Induced Glaucoma. Link.
• MedPage Today. (2017). Risks of Steroid Use for Glaucoma. Link.
• North Florida Cataract Specialists and Vision Care. (2015). Steroids and Cataracts: What You Should Know. Link.
• London Cataract Centre. (2025). How Do Corticosteroids Increase the Risk of Cataracts?. Link.
• GoodRx. (2025). 5 NSAID Eye Drops: A Full List of Options. Link.
• Verywell Health. (2024). Steroid Eye Drops: Types, Uses, Side Effects. Link.
• Mayo Clinic. (2025). Prednisone and other corticosteroids: Balance the risks and benefits. Link.
• Eyes On Eyecare. (2025). The Link Between Cataracts and Corticosteroids. Link.
• Feroze, K. B., Zeppieri, M., & Khazaeni, L. (2023). Steroid-Induced Glaucoma. In StatPearls. StatPearls Publishing. Link.
• EyeWorld. (2023). Identifying and handling steroid-induced glaucoma. Link.

Frequently Asked Questions

How long does it take for steroids to cause eye problems?

The time it takes for steroids to cause eye problems varies. An increase in intraocular pressure (IOP) can occur within a few weeks of starting topical steroids, but cataracts are typically a long-term complication developing after months or years of use.

Are steroid-induced eye conditions reversible?

Steroid-induced IOP elevation is often reversible if detected early and the steroid is discontinued. However, any vision loss from resulting glaucoma is irreversible. Steroid-induced cataracts are permanent and require surgery.

Can inhaled steroids cause eye problems?

Yes, even inhaled steroids can increase the risk of eye problems like elevated IOP and cataracts, particularly with long-term, high-dose use. The risk is generally lower than with topical or oral steroids, but regular monitoring is still recommended.

How are steroid-induced glaucoma and cataracts treated?

Steroid-induced glaucoma is managed by stopping the steroid if possible, or with pressure-lowering eye drops, laser therapy, or surgery if needed. Cataracts are treated with surgery to remove the cloudy lens and replace it with a clear artificial one.

What are the first signs of a steroid-induced eye condition?

Early signs can be subtle or non-existent. Symptoms to watch for include changes in vision, increased glare, halos around lights, or blurred vision. Elevated eye pressure often has no symptoms until the condition is advanced, highlighting the importance of regular eye exams.

Who is at the highest risk for steroid-induced eye conditions?

Individuals with a family history of glaucoma, a prior steroid response, diabetes, or high myopia are at higher risk. Young children and older adults also have an increased susceptibility.

Are there steroid alternatives for treating eye inflammation?

Yes, depending on the condition, non-steroidal anti-inflammatory drug (NSAID) eye drops or other non-steroidal medications may be used as alternatives to reduce inflammation, especially for post-surgical pain.