11 September 2023
BMJ Case Reports clinicians have highlighted the risks of self-treating with prescription medications after a patient developed steroid-induced glaucoma.
The man in his 70s presented with blurry vision in his right eye. He was found to have markedly elevated IOP, advanced optic disc cupping and tunnel vision.
The patient had been diagnosed with elevated intraocular pressure (IOP) 18-months previously and treated with antiglaucoma eye drops.
Closer questioning of the patient revealed that for the past three and a half years he had been using fixed combination 0.3% tobramycin/0.1% dexamethasone eye drops frequently to relieve ocular redness and discomfort in both eyes. His ophthalmologist was unaware of this.
After the patient stopped using the eye drops and completed two weeks of antiglaucoma therapy, his IOP returned to normal and his visual field remained stable.
“Our case highlights the danger of habitual self-treatment of prescription medications containing corticosteroids and the importance of taking a detailed medication history,” the authors highlighted.
Comments (4)
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ks210614 September 2023
This story highlights the importance of OSD resulting from glaucoma medication and why the push towards SLT is so crucial.
The importance of explaining to patients in HES that OSD will occur due to these meds and that it is imperative that either is concurrent lub is Rxd or a PF option is given by default to prevent glaucoma pxs stopping their meds and preventing such scenarios. Even optoms when seeing glaucoma pxs in primary care should be advising of lubs and their vital role and not waiting for symptoms/signs.
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ks210614 September 2023
This story highlights the importance of OSD resulting from glaucoma medication and why the push towards SLT is so crucial.
The importance of explaining to patients in HES that OSD will occur due to these meds and that it is imperative that either is concurrent lub is Rxd or a PF option is given by default to prevent glaucoma pxs stopping their meds and preventing such scenarios. Even optoms when seeing glaucoma pxs in primary care should be advising of lubs and their vital role and not waiting for symptoms/signs.
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Nicholas Rumney13 September 2023
Begs the Q who Rx'd this and who authorised repeat. Can guarantee it was not an IP optometrist ! This is why GP's are aggressively counselled by the HES never to Rx a steroid and why some medicines management bureau in ICB's interpret this as never in Primary Care. Obviously IP optometrists use and need house steroids regularly. Bet the GP didn't face GMC FTP hearing ?
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Anonymous13 September 2023
Over 25 years ago when I had just qualified and elderly gentleman came in to the practice and said his glaucoma drops were very uncomfortable and caused his eyes to go red and sting. I asked him to show be his glaucoma drops. He bought out a bottle with a solution he was putting in his eyes and much to my astonishment it was a solution that are used to clean spectacle lenses he had bought elsewhere. I told him this and he said that they were his glaucoma drops but he cleans his lenses with the other solution in a bottle. He had got confused with the drops and was cleaning his lenses with the glaucoma drops. I confiscated his lens cleaning drops and supplied him free of charge a plunger bottle with a weak lens cleaner to clean his specs. I reviewed him a week later. Problem solved.
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