clobetasol and Glaucoma

Steroid creams applied topically to the skin are routinely used in the treatment of many dermatoses. Their use on the face in severe atopic eczema is relatively common. We report a series of three patients who whilst using topical facial steroids developed advanced glaucoma. A further two cases of ocular hypertension secondary to topical facial steroids are also described. This is the first series of cases to be reported demonstrating the potentially blinding complications of topical facial steroids. Recommendations are made with regard to screening such patients for glaucoma.

Topics: Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Clobetasol; Dermatitis, Atopic; Desoximetasone; Facial Dermatoses; Female; Glaucoma; Humans; Hydrocortisone; Male; Ocular Hypertension; Prednisolone; Vision Disorders; Visual Acuity

Fluorometholone and clobetasone butyrate have been developed as ophthalmic corticosteroids because of their lesser potential to elevate intraocular pressure. Nevertheless, their primary use is the inhibition of an inflammatory response. Quantification of their anti-inflammatory effect in the rabbit cornea indicates that 0.1% fluorometholone and 0.1% clobetasone butyrate are effective, but weak, anti-inflammatory agents. An increase in concentration of fluorometholone to 0.25% failed to enhance its anti-inflammatory effectiveness significantly, while an increase in concentration of clobetasone butyrate to 0.5% did significantly increase its anti-inflammatory effect. As with all other corticosteroid bases studied to date, formulation of fluorometholone as an acetate derivative significantly increased its effectiveness, rendering it as effective as 1.0% prednisolone acetate, the most effective of commercially available ophthalmic corticosteroids.

Topics: Administration, Topical; Animals; Anti-Inflammatory Agents; Cell Movement; Clobetasol; Fluorometholone; Glaucoma; Keratitis; Neutrophils; Prednisolone; Rabbits