Effects of short-term topical or systemic corticosteroids on IOP

A Danish study, published in JAMA Dermatology,¹ found that topical and systemic corticosteroids used in the short term do not result in increased intraocular pressure (IOP) in adults with or without atopic dermatitis.

First author Diva Amiri, MD, is affiliated with the Copenhagen Research Group for Inflammatory Skin, Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen; and the Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, all in Denmark.

This study, which analyzed the results of 3 randomized clinical trials, is important because it adds to the limited body of knowledge about the effects of the use of short-term corticosteroids on the IOP.

“Increased IOP is a known adverse effect of corticosteroids and may lead to corticosteroid-induced glaucoma.² IOP typically normalizes after treatment cessation, but prolonged treatment can cause persistently increased IOP requiring antiglaucomatous treatment.² Atopic dermatitis is often treated with topical corticosteroids, yet concerns about ocular adverse effects limit their use on the face and contribute to undertreated facial atopic dermatitis. Evidence linking periocular topical corticosteroids to increased IOP is primarily based on case reports and series and retrospective studies.³ Long-term systemic corticosteroid treatment is associated with increased IOP.^2,4 However, clinical studies on the effects of short-term systemic corticosteroid and topical corticosteroid treatments on IOP are limited,” the investigators explained.

Corticosteroid study methodology

The 3 randomized clinical trials included in this study were:

1. The Risk of an Elevated Intraocular Pressure after Treatment with Topical Corticosteroids in the Periocular Region study (EU Clinical Trials Register Identifier: 2020-000252-35)
2. The Effects of Topical Corticosteroid Use on Insulin Sensitivity and Bone Turnover Study (NCT04114097)
3. The Effect of Curcumin on the Development of Prednisolone-Induced Hepatic Insulin Resistance Study (NCT04315350)

In study 1, which was an open-label randomized clinical trial that included patients with periocular atopic dermatitis and healthy controls, periocular hydrocortisone (1.0%) cream or hydrocortisone-17-butyrate (0.1%) cream was applied for 4 weeks; the healthy controls were untreated.

In study 2, a double-blind active comparator randomized clinical trial that included patients with atopic dermatitis, the patients were treated for 2 weeks with whole-body betamethasone 17-valerate (0.1%) plus placebo or tacrolimus (0.1%) twice daily, followed by 4 weeks of twice-weekly treatment.

In study 3, a double-blind randomized clinical trial, the male patients with atopic dermatitis who were overweight or obese but not diabetic were treated for 10 days with oral placebo or prednisolone (50 mg) or prednisolone (50 mg) plus curcumin (400 mg).

The main outcomes were the changes in IOP, which was the primary end point in study 1, and a predefined secondary end point in studies 2 and 3.

What did the analysis of the data from the three studies show?

In total, the 3 studies included 84 patients (34 women, 50 men) as follows: study 1, 24 patients (8 with periocular atopic dermatitis and 16 healthy treated and untreated controls); study 2, 36 patients with atopic dermatitis; and study 3, 24 overweight or obese males without diabetes.

Amiri and colleagues reported, “In study 1, the right eye IOP significantly decreased in patients with atopic dermatitis after treatment compared to the untreated controls (–2.5 mm Hg; 95% confidence interval, –3.9 to –1.1 mmHg; P = 0.002). No significant changes were observed in the left eye or among treated healthy controls. In studies 2 and 3, the IOP remained stable, with no significant changes.”

The investigators concluded that their analysis of the 3 randomized clinical trials showed that short-term corticosteroid treatment, whether periocular, whole-body, or systemic, did not increase the IOP. The caveat, however, is that while these findings support the short-term safety of the use of periocular topical corticosteroids, intolerance in patients with corticosteroid responsiveness cannot be excluded.

References

1. Amiri D, Hellmann PH, Thyssen JP, Skov L, Kolko M, Gether L. Intraocular pressure during short-term topical or systemic corticosteroid treatment: analysis of 3 randomized clinical trials. JAMA Dermatol. Published online May 13, 2026. doi:10.1001/jamadermatol.2026.1183

2. Roberti G, Oddone F, Agnifili L, et al. Steroid-induced glaucoma: epidemiology, pathophysiology, and clinical management. Surv Ophthalmol. 2020;65:458-72. doi:10.1016/j. survophthal.2020.01.002

3. Daniel BS, Orchard D. Ocular side-effects of topical corticosteroids: what a dermatologist needs to know. Australas J Dermatol. 2015;56:164-9. doi:10.1111/ajd.12292

4. Garbe E, LeLorier J , Boivin JF, Suissa S. Risk of ocular hypertension or open-angle glaucoma in elderly patients on oral glucocorticoids. Lancet. 1997;350:979-82. doi:10.1016/S0140-6736(97)03392-8