Risk Factors Associated With Steroid-Induced Ocular Hypertension and Glaucoma in Patients With Vernal Keratoconjunctivitis in a North Indian Population: A Multicenter Study.

Introduction Vernal keratoconjunctivitis (VKC) is a chronic allergic condition of the eye that often requires long-term steroid use for symptom control. However, prolonged or unsupervised steroid use can lead to serious complications like steroid-induced ocular hypertension (SIOHT) and steroid-induced glaucoma (SIG). Identifying patients at risk for these complications is crucial for timely intervention and preserving vision. Objectives This study aims to (1) identify and evaluate both steroid-related and non-steroid-related risk factors associated with SIOHT and SIG in patients with VKC and (2) compare clinical characteristics, including the type of steroid used, duration of use, and visual outcomes such as need for surgery and vision loss. Additionally, the study explores differences between urban and rural populations in terms of disease presentation, management, and outcomes. Methods A multicentric retrospective proforma-driven chart review conducted in four centers from April 2019 to March 2020 analyzed patient records for steroid use, urban/rural settings, family history of glaucoma, allergies, clinical features, and treatments. Results In a study of 2,360 VKC patients, 4.7% exhibited SIOHT and/or SIG. SIG and SIOHT prevalence was 53.5% and 46.5%, with mean presentation ages of 17.1 ± 5.9 and 16.4 ± 6.0 years, respectively. Topical dexamethasone (50%) was the most used steroid. Urban-rural disparities in age and steroid usage were significant. Successful management involved steroid withdrawal (10.3% eyes), anti-glaucoma medications (62.9% eyes), and surgery (24.9% eyes). Urban areas showed higher limbal VKC rates (23%) than rural areas (7.9%) (p = 0.01). Myopia was observed in 26.5% of SIG/SIOHT eyes, while hyperopia was observed in 2.8% of cases. Additionally, 29 rural and 11 urban patients had a history of allergy (p = 0.1). The findings highlight demographic variations, steroid implications, and management strategies in VKC patients with SIG and SIOHT. Conclusion The study highlights the significant impact of glaucoma in VKC patients, revealing that 25% require surgery. Urban areas show higher limbal VKC rates, possibly linked to air pollution. Surprisingly, even milder steroids may induce SIG and SIOHT. The results have broad relevance, as they stem from the genetic and anthropological traits of North Indian populations.