Over-the-Counter Corticosteroid Eye Drops and Steroid-Induced Glaucoma: A Narrative Review

Abstract

Background: Steroid-induced glaucoma (SIG) is a severe, iatrogenic form of secondary open-angle glaucoma. The widespread, unregulated availability of over-the-counter (OTC) topical corticosteroids has exacerbated this preventable cause of irreversible blindness, particularly in developing nations. Aims and scope: This narrative review evaluates the pathophysiology of SIG, the public health implications of OTC corticosteroid misuse, and current clinical management strategies. Methods: A comprehensive literature search was conducted using databases such as PubMed and Scopus. Thirty peer-reviewed articles, predominantly published between 2020 and 2026, were selected. Keywords included "steroid-induced glaucoma," "over-the-counter," "corticosteroid eye drops," and "trabecular meshwork." Result: Chronic exposure to topical corticosteroids induces molecular changes in the trabecular meshwork, including extracellular matrix deposition and cross-linked actin network formation, leading to increased outflow resistance and elevated intraocular pressure (IOP). The unregulated sale of potent steroids (e.g., dexamethasone) for minor ocular irritations allows for prolonged, unsupervised use. Patients often present late with advanced optic neuropathy due to the asymptomatic nature of the disease. Management primarily involves the immediate discontinuation of the offending steroid, followed by medical or surgical IOP-lowering interventions. Conclusion: The unrestricted access to OTC corticosteroid eye drops poses a significant threat to public health. Mitigating the incidence of SIG requires a multifaceted approach, including stricter pharmaceutical regulations, enhanced public education, and heightened clinical vigilance among general practitioners and pharmacists.