A patient develops a steroid-induced rise in IOP after prolonged use of topical dexamethasone 0.1% for allergic conjunctivitis. The pathomechanism of steroid glaucoma primarily involves:

• A Increased production of aqueous humor by the ciliary body
• B Deposition of glycosaminoglycans in the trabecular meshwork reducing outflow ✓
• C Pupillary block due to posterior synechiae
• D Decreased episcleral venous drainage

Explanation

Corticosteroids cause a steroid response by inducing accumulation of glycosaminoglycans (extracellular matrix materials) and increasing the production of fibronectin, laminin, and other proteins in the trabecular meshwork. This reduces aqueous outflow facility, resulting in IOP elevation. The mechanism is specifically at the level of trabecular meshwork outflow resistance — not increased production, pupillary block, or episcleral venous changes. Steroid responders (approximately 35% of the general population) show this IOP rise within 2–6 weeks of topical steroid use.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.