Changes in Intraocular Pressure with Use of Periocular Triamcinolone Cream


Purpose: To evaluate the effect of periocular topical triamcinolone cream on intraocular pressure.

Methods: A retrospective chart review identified 57 patients, 114 eyes using triamcinolone cream (0.1%, 0.025%) with subsequent intraocular pressure (IOP) checks at three follow-up visits. Descriptive, univariate, and multivariate analyses were performed to assess effects of age, therapy duration, consecutive weeks on steroid, prescription strength, time of day, and method of measurement on IOP levels. Generalized Estimating Equations were used in regression models to account for correlation of eyes within subjects and across visits.

Results: We identified 57 patients using triamcinolone cream for allergic or eczematous dermatitis of the eyelid. Prescription strengths were 0.025% or 0.1% and patients were followed for a median of 4.9 months. Measurements of IOP at baseline did not change as compared to all IOP measurements at follow-ups and did not change with steroid strength. The mean change in IOP at all follow-up visits was 0.07 mm Hg (95% confidence interval [CI]: –0.36, 0.50). After adjustment for the method of tonometer and the patient’s age, the mean change was 0.03 mm Hg (95% CI: –0.68, 0.73, P = 0.93). Prescription strength and consecutive weeks of therapy were not associated with IOP. Two patients experienced a significant elevation in IOP of >10 mm Hg, one through the concomitant consequences of systemic corticosteroids usage and the other through prolonged topical application.

Conclusion: In patients taking periocular triamcinolone cream, there was no clinically meaningful change in mean IOP between baseline and follow-up visits, and IOP measurements were not related to variances in prescription strength or duration of therapy.


Glaucoma, Intraocular Pressure, Ocular Hypertension, Periocular Dermatitis, Steroids, Triamcinolone

1. Nutten S. Atopic dermatitis: Global epidemiology and risk factors. Ann Nutr Metab 2015;66:8–16.

2. Kanwar AJ. Adult-onset atopic dermatitis. Indian J Dermatol 2016;61:662–663.

3. Kersey JP, Broadway DC. Corticosteroid-induced glaucoma: A review of the literature. Eye 2006;20:407–416.

4. Bernstein HN, Mills DW, Becker B. Steroid-induced elevation of intraocular pressure. Arch Ophthalmol 1963;70:15–18.

5. François J. Corticosteroid glaucoma. Ophthalmologica 1984;188:76–81.

6. Herschler J. Increased intraocular pressure induced by repository corticosteroids. Am J Ophthalmol 1976;82:90– 93.

7. Phulke S, Kaushik S, Kaur S, Pandav SS. Steroid-induced glaucoma: An avoidable irreversible blindness. J Curr Glaucoma Pract 2017;11:67–72.

8. Cantrill HL, Palmberg PF, Zink HA, Waltman SR, Podos SM, Becker B. Comparison of in vitro potency of corticosteroids with ability to raise intraocular pressure. Am J Ophthalmol 1975;79:1012–1017.

9. Bernstein HN, Schwartz B. Effects of long-term systemic steroids on ocular pressure and tonographic values. Arch Ophthalmol 1962;68:742–753.

10. Cubey RB. Glaucoma following the application of corticosteroid to the skin of the eyelids. Br J Dermatol 1976;95:207–208.

11. Garrott HM, Walland MJ. Glaucoma from topical corticosteroids to the eyelids. Clin Exp Ophthalmol 2004;32:224–226.

12. Vie R. Glaucoma and amaurosis associated with long-term application of topical corticosteroids to the eyelids. Acta Derm Venereol 1980;60:541–542.

13. Zugerman C, Saunders D, Levit F. Glaucoma from topically applied steroids. Arch Dermatol 1976;112:1326.

14. Aggarwal RK, Potamitis T, Chong NH, Guarro M, Shah P, Kheterpal S. Extensive visual loss with topical facial steroids. Eye 1993;7:664–666.

15. Sahni D, Darley CR, Hawk JL. Glaucoma induced by periorbital topical steroid use—A rare complication. Clin Exp Dermatol 2004;29:617–619.

16. Garbe E, Lelorier J, Boivin JF, Suissa F. Inhaled and nasal glucocorticoids and the risk of ocular hypertension or open-angle glaucoma. Am J Rhinol 1997;11:247.

17. Maeng MM, De Moraes CG, Winn BJ, Glass LR. Effect of topical periocular steroid use on intraocular pressure: A retrospective analysis. Ophthal Plast Reconstr Surg 2019;35:465–468.

18. Tamagawa-Mineoka R, Yasuoka N, Ueta M, Katoh N. Influence of topical steroids on intraocular pressure in patients with atopic dermatitis. Allergol Int 2018;67:388–391.

19. Han X, Niu Y, Guo X, Hu Y, Yan W, He M. Age-related changes of intraocular pressure in elderly people in Southern China: Lingtou Eye Cohort Study. PLoS One 2016;11:e0151766.

20. Wong TT, Wong TY, Foster PJ, Crowston JG, Fong CW, Aung T, et al. The relationship of intraocular pressure with age, systolic blood pressure, and central corneal thickness in an asian population. Invest Ophthalmol Vis Sci 2009;50:4097–4102.

21. Onochie C, Okoye O, Ogunro A, Aribaba T, Hassan K, Onakoya A. Comparisons of the Tono-Pen® and Goldmann Applanation Tonometer in the measurement of intraocular pressure of primary open angle glaucoma patients in a hospital population in Southwest Nigeria. Med Princ Pract 2016;25:566–571.

22. Ting SL, Lim LT, Ooi CY, Rahman MM. Comparison of icare rebound tonometer and Perkins applanation tonometer in community eye screening. Asia Pac J Ophthalmol 2019;8:229–232.

23. Haeck IM, Rouwen TJ, Timmer-de Mik L, de Bruin-Weller MS, Bruijnzeel-Koomen CA. Topical corticosteroids in atopic dermatitis and the risk of glaucoma and cataracts. J Am Acad Dermatol 2011;64:275–281.

24. Gutfreund K, Bienias W, Szewczyk A, Kaszuba A. Topical calcineurin inhibitors in dermatology. Part I: Properties, method and effectiveness of drug use. Postepy Dermatol Alergol 2013;30:165–169.

25. Feroze KB, Khazaeni L. Steroid induced glaucoma. StatPearls Publishing; 2020.

26. Jonas JB, Kreissig I, Degenring R. Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol 2003;87:24–27.