Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
BMJ Case Rep. 2023 Sep 4;16(9):e254709. doi: 10.1136/bcr-2023-254709.
A man in his 70s on regular follow-up with an ophthalmologist for 10 years presented with blurry vision in his right eye for 4 days. He was diagnosed with elevated intraocular pressure (IOP) bilaterally 18 months earlier and treated with antiglaucoma eye-drops. On direct questioning, he admitted to using fixed combination tobramycin 0.3%/dexamethasone 0.1% eye-drops frequently to relieve ocular redness and discomfort in both eyes for 3.5 years without his ophthalmologist's knowledge. Examination disclosed markedly elevated IOP, advanced optic disc cupping and tunnel vision due to steroid-induced glaucoma bilaterally. After cessation of the eye-drops and 2 weeks of antiglaucoma therapy, his IOP returned to normal and his visual field remained stable for 4 years.Our case highlights the danger of habitual self-treatment of prescription medications containing corticosteroids and the importance of taking a detailed medication history in the diagnosis and management of steroid-induced glaucoma.
一位 70 多岁的男性，10 年来定期接受眼科医生的随访，因右眼视力模糊 4 天就诊。18 个月前他被诊断为双侧眼压升高，并接受了抗青光眼眼药水治疗。经直接询问，他承认在未经眼科医生同意的情况下，3.5 年来经常使用固定剂量的妥布霉素 0.3%/地塞米松 0.1%眼药水来缓解双眼的眼红和不适。检查发现双侧眼压明显升高，视盘凹陷和隧道视野，这是由于类固醇引起的青光眼。停止使用眼药水并接受 2 周的抗青光眼治疗后，他的眼压恢复正常，视野在 4 年内保持稳定。我们的病例强调了习惯性自行使用含有皮质类固醇的处方药物的危险，以及在诊断和管理类固醇性青光眼时详细询问用药史的重要性。
