Steroid-Induced Glaucoma in Asthma: A Case Report Highlighting the Steroid-Sparing and Disease-Modifying Potential of Allergen Immunotherapy

  • Shambo Samrat Samajdar
  • Shatavisa Mukherjee
  • Rupak Chatterjee
  • Saibal Moitra
  • Shashank R Joshi

Abstract

Background: Glaucoma, a leading cause of irreversible vision loss, is a known adverse effect of corticosteroid therapy, including inhaled corticosteroids (ICS). This case highlights the rare occurrence of steroid-induced glaucoma in an asthma patient treated with ICS and the role of allergen immunotherapy (AIT) in achieving steroid-sparing and long-term disease control.

Case Summary: A 34-year-old male with asthma developed steroid-induced glaucoma twice while on budesonide/formoterol therapy, with elevated intraocular pressure (IOP) of 32 mm Hg and 28 mm Hg, respectively. Cessation of ICS led to normalization of IOP. Due to intolerance to ICS, he was initiated on subcutaneous immunotherapy (SCIT) for house dust mite allergens. Over three years of SCIT, the patient achieved effective asthma control without requiring ICS or other controller medications. Post-SCIT, he reported only two minor exacerbations managed with short-acting beta-agonists.

Discussion: Causality assessment using WHO-UMC criteria and the Naranjo algorithm confirmed the association between ICS and glaucoma. SCIT provided a steroid-sparing alternative, reducing the need for pharmacotherapy and preventing the recurrence of steroid-related ocular complications. This case underscores the importance of pharmacovigilance in ICS use and highlights AIT's disease-modifying potential in asthma management.

Conclusion: This case illustrates the rare occurrence of ICS-induced glaucoma and emphasizes the role of AIT in achieving long-term asthma control while minimizing adverse effects of corticosteroids. Future research should further evaluate AIT as a viable therapeutic option for selecting asthma populations intolerant to ICS

Published
2024-12-16
Section
CASE REPORT