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Topical steroids are invaluable in controlling numerous inflammatory skin conditions. However, they can produce significant adverse effects if used inappropriately and without supervision as illustrated in the case below.A 43-year-old male attended the ophthalmology department with a 2-week history of painless reduction in vision in his left eye. Past ophthalmic history included bilateral allergic conjunctivitis, primary open angle glaucoma (POAG) right eye, and ocular hypertension left eye, diagnosed on his first visit 18 months ago. Systemic enquiry revealed a history of asthma, hypertension, obesity, epilepsy, and atopic eczema. Current ophthalmic treatments included nedocromil sodium and latanoprost to both eyes. His only previous exposure to ophthalmic steroids was a 4-week course of dexamethasone 0.1% q.i.d. (standard practice) following uncomplicated left cataract surgery 8 months ago. Intraocular pressures (IOP) 6 weeks post-surgery were 23 and 18 mmHg right and left eye respectively.Ocular findings were as follows: Snellen acuity 6/9; hand movement with IOP of 46 and 56 mmHg in the right eye and left eye respectively (upper limit of normal IOP is 21 mmHg). Both …

Irreversible visual loss secondary to excessive topical steroid use in eczema