Steroid induced glaucoma mechanism

An acute myopathy has been observed with the use of high doses of corticosteroids, most often occurring in patients with disorders of neuromuscular transmission (., myasthenia gravis ), or in patients receiving concomitant therapy with neuromuscular blocking drugs (., pancuronium). This acute myopathy is generalized, may involve ocular and respiratory muscles, and may result in quadriparesis . Elevations of creatine kinase may occur. Clinical improvement or recovery after stopping corticosteroids may require weeks to years.

After the plate is attached to the globe, the tube is laid across the cornea and cut with a sharp scissors to create a beveled edge with the opening toward the cornea. The tube should extend approximately to 3 mm into the anterior chamber to minimize the risk of tube-cornea touch or retraction out of the anterior chamber. A 23-gauge needle is used to create a track through which the tube is inserted into the anterior chamber just anterior and parallel to the iris. The tube may be secured to the sclera a few millimeters anterior to the plate with 7- 0 or 8-0 Vicryl suture. This suture helps to stabilize the tube and should not be tight; otherwise, it will restrict flow in valved devices.

Cells of the zona fasciculata and zona reticularis lack aldosterone synthase (CYP11B2) that converts corticosterone to aldosterone, and thus these tissues produce only the weak mineralocorticoid corticosterone. However, both these zones do contain the CYP17A1 missing in zona glomerulosa and thus produce the major glucocorticoid, cortisol. Zona fasciculata and zona reticularis cells also contain CYP17A1, whose 17,20-lyase activity is responsible for producing the androgens, dehydroepiandosterone (DHEA) and androstenedione. Thus, fasciculata and reticularis cells can make corticosteroids and the adrenal androgens, but not aldosterone.

* Mydriatics and cycloplegics. While certainly not a systemic medication, it is worth noting that topical tropicamide may cause increased IOP via mechanisms other than angle closure. After examining IOP fluctuations in children given mydriatics, researchers found an average increase of 2mm Hg; however, a potential increase or decrease of 8mm Hg was documented in many patients with open angles. 27 The investigators concluded that some alteration in aqueous dynamics occurred upon dilation and, because of the variable effect on IOP (even without the presence of anterior segment complications), all patients who use mydriatics require observation. 27

Diagnosis of reactive arthritis (including the condition formerly called Reiter’s syndrome) is mainly clinical.  There are no validated diagnostic criteria, however some guidance for diagnosis is available. [18, 19, 20, 10]   In 1995, the Third International Workshop on Reactive Arthritis established criteria for diagnosing reactive arthritis.  The main criteria involve the pattern of joint involvement and the timing of the onset of the condition (such as soon after an infection).  Diagnosis of Reiter’s syndrome has essentially been replaced with diagnosis of the broader category in which it resides:  Reactive Arthritis.

Steroid induced glaucoma mechanism

steroid induced glaucoma mechanism

* Mydriatics and cycloplegics. While certainly not a systemic medication, it is worth noting that topical tropicamide may cause increased IOP via mechanisms other than angle closure. After examining IOP fluctuations in children given mydriatics, researchers found an average increase of 2mm Hg; however, a potential increase or decrease of 8mm Hg was documented in many patients with open angles. 27 The investigators concluded that some alteration in aqueous dynamics occurred upon dilation and, because of the variable effect on IOP (even without the presence of anterior segment complications), all patients who use mydriatics require observation. 27

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