Will steroid eye drops after ReLEx® SMILE® cause a harmful increase in eye pressure?

Hi Ash

Just to provide a bit of background information, eye pressure (Intraocular pressure/IOP) needs to be within a certain range for optimum health of the eye. It should not be too low, and neither should it be too high.

Anywhere within a range of around 10mmHg to 21mmHg is generally considered acceptable, bearing in mind that a small proportion of people may have weaker nerves that are susceptible to damage with IOPs less than 21.

In your case, the question really is, is your increased eye pressure of any concern? If it is so high as to be a genuine concern, you would be better off not having any surgery. Otherwise, if it is within the generally acceptable range and your optic nerves are healthy, then you should not worry about anything at all.

In other words, steroid drops and their possible side effects don't necessarily come into consideration at all.

Steroid eyedrops are used after many kinds of eye surgery, to limit the amount of inflammation that occurs. Usually, after LASIK or SMILE they are only used for a short time of around 1-2 weeks after surgery.

If you took a group of people and gave them steroid eyedrops, a proportion of them (but not all) could develop high eye pressure/IOP some time after starting the drops (this is called a steroid response). The time it takes to happen is variable but is usually a few weeks, and depends on things like the individual susceptibility, the type of steroid being used, and the frequency the steroid drops are being applied.

The most important thing with using steroid eyedrops, is that the doctor prescribing them should monitor the eye pressure from time to time. If the eye pressure is noted to rise with steroid eyedrops, those eyedrops should be stopped and the IOP would eventually come back down to normal again if it was detected early. As long as the period of IOP rise is short, the possibility of optic nerve damage is minimized.

So to recap:

1. The possibility of steroid response is not necessarily relevant to you. You need to ask your doctor-is the IOP so high that surgery is not possible? If not then you should not worry about it.

2. Steroid eyedrops can cause an eye pressure rise in some people, after they have been used for some time. This is true no matter what the operation was or what the steroid is being used for. If the IOP rises, and the steroid is then stopped, the IOP almost always comes back to normal again.

Steroid eyedrops are often used for a short period of time following LASIK or ReLEx SMILE to help with reducing post-operative inflammation.

Your surgeon will usually check your intraocular pressure to determine that it is within the normal range both before and after your surgery.

Should you have a rise in intraocular pressure whilst on steroid eyedrops, the situation is often easily managed either by stopping the use of the steroid drops or adding another pressure lowering drop to allow the use of steroid to continue until such time it is no longer required. The intraocular pressure usually normalises after the steroid drops are stopped.

Dr David Chan

To answer your question, yes, steroids eyedrops may cause an increase in eye pressure in anyone after any procedure. Fortunately it does not happen to everyone and only 20-40% of the population - of which only 5% will develop a severely high eye pressure.

It is therefore in your best interest for your eye surgeon to see you regularly after any procedure to have your eyes checked, including measuring your eye pressure.

Most of the time, the steroid eyedrop is stopped after 2-4 weeks after treatment so the occurrence of high eye pressure is less since the exposure time to the steroids is short. Hence the anti-inflammatory effects of steroids far outweigh the potential risks, in the hands of a good eye doctor.

In other words, it is safe as long as you are being taken care of by a good eye doctor!

Hope that helps!

Dr Claudine Pang