Steroid Induced Glaucoma in a Child with Acute Lymphoblastic Leukemia - An Overlooked Complication

An asymptomatic 6-year-old boy was identified in our school screening camp with defective vision in both eyes and referred to us for refractory error evaluation. He was found to have corneal edema as a consequence of very high intraocular pressure (IOP) in both the eyes. On further evaluation, no congenital ocular anomalies which could lead to IOP elevation were found. He had earlier been diagnosed with acute lymphoblastic leukemia at 3 years of age and was on repeated cycles of systemic steroid therapy. Consequent to this, the child had developed raised IOP and steroid-induced secondary open-angle glaucoma with irreversible damage of the optic nerve in both eyes. He was started on topical anti-glaucoma medications and his IOP was brought under control with no worsening of optic nerve damage. This report highlights the possibility of steroid-induced glaucoma in the pediatric age group due to systemic steroid therapy and the necessity for timely referral to the ophthalmologist to avoid needless and irreversible blindness due to glaucoma. KEYWORDS glaucoma, steroids, raised intraocular pressure