Steroid Induced Glaucoma

Posted on April 2, 2026April 15, 2026 by Dr Shibal Bhartiya

Steroids carry a risk that many patients, and even some prescribing doctors, overlook. They can silently raise the pressure inside…

Glaucoma: Are you at risk?

Posted on July 3, 2018April 9, 2026 by Dr Shibal Bhartiya

Glaucoma usually has no symptoms in its early stages. By the time a patient notices something is wrong, significant and…

Eye Allergy: Causes, Symptoms, and Treatment

Eye allergies are extremely common in Gurgaon. Dust, pollution, pollen, and air conditioning; often all in the same day; make allergic eye disease one of the most frequent complaints I see in my clinic. It is a disease of the ocular surface, and invariably associated with dry eyes.

The medical term is allergic conjunctivitis. It means the conjunctiva, the thin transparent membrane covering the white of your eye, has reacted to an allergen. The result is redness, itching, watering, and swelling. It is not contagious. You cannot catch it from someone else, and they cannot catch it from you.

Dr Shibal Bhartiya is a fellowship-trained eye specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.

What Causes Eye Allergies?

The most common trigger in Gurgaon is airborne. This includes dust, vehicle exhaust, construction dust, and pollen from seasonal plants. These particles land on the surface of the eye and set off an immune response. Your immune system treats them as a threat. Mast cells in the conjunctiva release histamine. That histamine is what causes the itching, redness, and watering.

Common causes include:

Seasonal triggers. Pollen from grasses, trees, and weeds. In Delhi-NCR, spring and the post-monsoon transition are the worst periods. Mould spores during the monsoon also cause flares.

Perennial triggers. Dust mites, pet dander, cockroach allergens, and smoke. These cause low-grade symptoms all year round. Air conditioning, paradoxically, can help by filtering air, but poorly maintained AC units recirculate allergens.

Contact triggers. Eye makeup, contact lens solutions, preservatives in eye drops, and certain skin creams that migrate toward the eyes. These cause localised reactions that patients often mistake for infections.

Vernal keratoconjunctivitis. A more severe, chronic form seen mainly in young boys in hot climates. It causes intense itching, a ropy mucus discharge, and large cobblestone-like bumps under the upper eyelid. It needs specialist attention because it can affect the cornea.

What Are the Symptoms of Eye Allergy?

The most reliable sign is intense itching. If your eyes itch, think allergy first. Infections hurt; allergies itch.

Other symptoms include:

Redness of the white of the eye
Watering and tearing
Swelling of the eyelids, especially on waking
A burning or gritty feeling
Sensitivity to light
Ropy or stringy mucus discharge (more common in vernal keratoconjunctivitis)
Temporary blurring of vision when mucus is present

Itching that gets worse when you rub your eyes. Rubbing your eyes makes the itch worse, this is a classic pattern. Rubbing releases more histamine and creates a cycle. Resist the urge. Rubbing hard and repeatedly can, over time, contribute to a corneal condition called keratoconus.

Eye Allergy vs Conjunctivitis: How to Tell the Difference

Both cause red, watery eyes. The key differences are:

	Eye Allergy	Infective Conjunctivitis
Itching	Intense	Mild or absent
Discharge	Watery or ropy	Sticky, yellow or green pus
Both eyes affected	Usually	Often starts in one eye
Contagious	No	Often yes
Associated with cold or fever	Rarely	Sometimes

If you are unsure, see your doctor before starting any eye drops. Steroid drops, which are appropriate for some allergy cases, can cause serious harm if used for an infection. Steroid eyedrops should only be taken when prescribed by your doctor.

Treatment of Eye Allergy

Avoid the trigger first

Identifying and removing the cause is the most effective treatment. This is not always possible, but some steps help consistently:

Use wrap-around sunglasses outdoors. They reduce pollen and dust reaching the eye by a significant margin.
Keep windows closed during high-pollen periods. Use air purifiers indoors.
Change pillowcases frequently. Dust mites live in bedding.
Remove eye makeup before sleeping and review your makeup products if symptoms started around the same time you changed brands.
Cold compresses, a clean cotton pad soaked in cold water held over the closed eyes, reduce swelling and soothe itching quickly.

Medical treatment

Preservative-free lubricating eye drops (artificial tears) dilute allergens and flush them off the eye surface. They also ease dryness. These are safe to use frequently and are usually the first step.

Antihistamine eye drops block the histamine response and give faster symptom relief. They reduce redness and itching. Many are available over the counter, but prescription-strength options work better for moderate to severe cases.

Mast cell stabiliser eye drops work differently — they prevent mast cells from releasing histamine in the first place. They need to be started before allergy season begins and used consistently. They are not effective for acute relief, but they reduce the overall severity of the season.

Combination drops that contain both an antihistamine and a mast cell stabiliser are now available and are often the most practical option for patients with seasonal disease.

NSAID eye drops (non-steroidal anti-inflammatory agents) reduce inflammation and ease discomfort without the risks associated with steroids.

Steroid eye drops are reserved for severe cases that do not respond to other treatments. They are effective but carry real risks, elevated eye pressure, cataract formation, and susceptibility to infection- with prolonged use. They must be used only under medical supervision, with regular monitoring of eye pressure. Do not buy them over the counter.

Oral antihistamine tablets can help when symptoms include nasal congestion or skin symptoms alongside eye symptoms, suggesting a more generalised allergic response.

The Glaucoma and Steroid Drops Warning

This is worth saying directly. Steroid eye drops, even short courses, can raise intraocular pressure in susceptible individuals. If you have glaucoma, a family history of glaucoma, or have previously been told you have high eye pressure, you must tell your doctor before starting any steroid drops. Steroid-induced glaucoma is preventable, but only if your doctor knows your risk.

When Should You See a Doctor?

Most mild eye allergies can be managed with lubricating drops and allergen avoidance. See your doctor if:

Symptoms are not improving after a few days of self-care
There is significant pain, not just itching
Vision is affected
The discharge is thick and yellow or green
Symptoms are in a child who is rubbing their eyes excessively
You have been using steroid drops bought from a pharmacy for more than two weeks

A Note on Eye Rubbing and Children

Children with eye allergies rub their eyes constantly. Parents often interpret this as infection and reach for antibiotic drops — which do nothing for allergies. The more important risk is corneal damage from chronic rubbing. If your child’s eyes itch repeatedly during certain seasons, have them seen by an ophthalmologist. A diagnosis of allergic conjunctivitis in a child also warrants a check for refractive error — children with uncorrected vision sometimes rub their eyes for reasons unrelated to allergy, and the two can coexist.

FAQs: Eye Allergy

What is eye allergy and what causes it?

Eye allergy, also called allergic conjunctivitis, occurs when the eyes react to an allergen such as dust, pollen, smoke, pet hair, or cosmetic products. The immune system triggers inflammation of the conjunctiva, causing redness, itching, swelling, and watering.

What are the symptoms of eye allergy?

Symptoms include intense itching, redness, watering, swelling of the eyelids and conjunctiva, a burning or gritty sensation, and sensitivity to light. Unlike infective conjunctivitis, discharge is usually clear and watery rather than thick or coloured.

What is the difference between seasonal and perennial eye allergy?

Seasonal allergic conjunctivitis occurs at specific times of year, typically triggered by pollen or mould spores. Perennial allergic conjunctivitis is present throughout the year and is usually triggered by dust mites, pet hair, smoke, or indoor pollutants.

Is eye allergy contagious?

No. Allergic conjunctivitis is not contagious and does not spread from person to person. This distinguishes it from viral or bacterial conjunctivitis, which can spread through direct or indirect contact.

How do I know if my red itchy eye is allergy or infection?

Allergy usually causes intense itching, clear watery discharge, and symptoms in both eyes. Infection more commonly causes thick coloured discharge, one eye affected first, and may be associated with recent contact with an infected person. A doctor can confirm the cause on examination.

Can dust and pollution in Gurgaon make eye allergy worse?

Yes. High ambient dust and pollution levels in Gurgaon and the Delhi-NCR region are common triggers for perennial allergic conjunctivitis. Seasonal pollen from trees and grass adds to the burden during spring and monsoon months. Wearing wrap-around sunglasses outdoors and using preservative-free lubricant drops after outdoor exposure can help reduce the allergen load on the eye surface.

What eye drops are used to treat eye allergy?

Treatment depends on severity. Preservative-free lubricant drops reduce allergen load and improve comfort. Antihistamine drops reduce redness and the allergic response. Mast cell stabiliser drops provide longer-term protection, especially for seasonal and perennial allergy. NSAID drops reduce inflammation. Steroid drops are reserved for severe cases not responding to other treatment and must be used under medical supervision.

Are steroid eye drops safe for eye allergy?

Steroid drops are effective for severe allergic eye disease but carry risks with prolonged use, including raised eye pressure and cataract. They must only be used under the supervision of an eye doctor and are not a first-line treatment.

Can rubbing the eyes during an allergy attack cause long-term damage?

Yes. Repeated vigorous eye rubbing during allergic episodes is associated with keratoconus — a progressive thinning and forward bulging of the cornea. Cold compresses and antihistamine drops are safer ways to relieve the itching urge.

When should I see an eye doctor for eye allergy?

See an eye doctor if symptoms are severe, persistent, or affecting vision; if there is significant eyelid swelling; if antihistamine drops are not helping; or if you are unsure whether the cause is allergy or infection. Steroid drops should only be started after a proper examination.

Read the research articles

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. This article was edited in April 2026.

She has published peer-reviewed research on eye care, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

Her work can be accessed on Pubmed, Google Scholar, ResearchGate and ORCID.

Dr Shibal Bhartiya
Glaucoma • Second Opinion • Advanced Care

www.drshibalbhartiya.com
+91 88826 38735

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Types of Glaucoma: Open Angle, Closed Angle, Normal Tension, and More

Types of Glaucoma: Open Angle, Closed Angle, Normal Tension, and More, explained by Dr Shibal Bhartiya, glaucoma specialist in Gurgaon.

Glaucoma is not a single disease. It is a family of conditions, each with different causes, risk factors, and treatment approaches. What they share is a common outcome: damage to the optic nerve, leading to progressive and irreversible vision loss if untreated.

Understanding which type of glaucoma you have helps you ask better questions and follow your treatment plan with more confidence. This page explains the main types, from the most common to the less well known, written for patients rather than clinicians.

Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.

Not all glaucomas behave the same way, and the treatment that is right for open-angle glaucoma may be wrong for angle-closure or normal tension glaucoma. Getting the diagnosis right, and the type right, is where good glaucoma care begins.

If you are uncertain about your diagnosis, a structured second opinion can bring clarity.

THE TWO MAIN TYPES OF GLAUCOMA

Q1. What is the difference between open-angle and closed-angle glaucoma?

Most glaucomas fall into one of two broad categories, determined by the anatomy of the drainage angle of the eye.

Open-angle glaucoma is by far the more common type of glaucoma. The drainage angle is open and appears normal, but fluid drains too slowly, causing pressure to build gradually over months and years. It has no symptoms in the early stages. Patients typically lose peripheral vision first, and the brain compensates so well that many people do not notice the loss until the disease is advanced. This is why regular screening is essential, particularly for those with risk factors.

Closed-angle glaucoma occurs when the drainage angle is narrow or blocked, preventing fluid from draining. It can occur suddenly (acute angle closure) or gradually (chronic angle closure). The acute form is a medical emergency with symptoms including severe eye pain, redness, blurred vision, and nausea. The chronic form is subtler and may mimic open-angle glaucoma.

Note: The distinction between the two types of glaucoma (open and closed angle) is made using a test called gonioscopy. This single test shapes all subsequent treatment decisions.

CLOSED-ANGLE GLAUCOMA

Q2. I have been diagnosed with angle-closure glaucoma. What does that mean for me?

In angle-closure glaucoma, the iris (the coloured part of the eye) is too close to the drainage angle, narrowing or blocking it. When the angle closes, fluid cannot drain and eye pressure rises sharply.

The acute form causes a sudden, severe rise in pressure. Symptoms include a red, painful eye with blurred vision, coloured halos around lights, headache, and nausea. This is an eye emergency; seek immediate medical help if this happens.

The chronic form builds more slowly, with few symptoms other than occasional coloured halos and mild headaches. It can go undetected for years without a formal eye examination.

Treatment for angle-closure glaucoma starts with a laser procedure called laser peripheral iridotomy (LPI). This creates a small opening in the iris to provide an alternative drainage pathway. After LPI, some patients require no further treatment; others need long-term eye drops. Your doctor will monitor your pressure and angle anatomy over time.

Note: Family members of patients with angle-closure glaucoma have a higher risk of the same condition. Preventive laser iridotomy can be offered to at-risk relatives before any acute episode occurs.

NORMAL TENSION GLAUCOMA

Q3. My doctor says I have glaucoma, but my eye pressures are normal. How is that possible?

This is understandably confusing. Between 10 and 25 percent of people with glaucoma have eye pressures that fall within the normal range (below 21 mmHg). This is called normal tension glaucoma (NTG), or low tension glaucoma.

The exact cause is not fully understood. Two leading theories are that the optic nerve is unusually sensitive to pressure and sustains damage even at pressures that would be harmless in most people, or that the blood supply to the optic nerve is compromised, making it vulnerable to damage independent of pressure. Of all the types of glaucoma, this is perhaps the most confusing for patients.

Conditions associated with normal tension glaucoma include:

Japanese ancestry (NTG is significantly more common in East Asian populations)
A family history of normal tension glaucoma
Migraines and vasospastic disorders such as Raynaud’s disease
Sleep apnoea
Alzheimer’s disease

Treatment still focuses on lowering eye pressure, like all other types of glaucoma. Even when eye pressure is within the normal range to start with, clinical trials have shown this slows progression. Eye drops, laser, or surgery may be used depending on the rate of progression and individual risk factors.

Note: Normal tension glaucoma often progresses more slowly than high-pressure glaucoma, but regular monitoring is still essential. Missing follow-up appointments is the most common reason for avoidable vision loss.

OCULAR HYPERTENSION

Q4. My eye pressures are high but my doctor says I do not have glaucoma. What is ocular hypertension?

If your eye pressure is above the normal range but your optic nerve and visual field show no signs of damage, you have ocular hypertension (OHT). It is not glaucoma, but it is a significant risk factor for developing glaucoma.

Not everyone with high eye pressure will develop glaucoma. Your individual risk depends on your age, ethnicity, family history, and corneal thickness (thicker corneas can give falsely high pressure readings).

Your doctor will weigh your risk profile before deciding whether to treat. Options include eye drops or selective laser trabeculoplasty (SLT). In lower-risk patients, careful monitoring without treatment is often appropriate, since all glaucoma medications carry some side effect burden.

Whether or not you receive treatment, regular eye checks are essential. The goal is to detect any optic nerve or visual field changes before significant vision is lost. Knowing your risk early is one of the best things you can do for your vision.

GLAUCOMA SUSPECT

Q5. My doctor says I am a glaucoma suspect. My tests were normal. Why do I still need annual monitoring?

A glaucoma suspect is someone whose optic nerve appearance raises concern, even when eye pressure and visual field tests are currently normal.

The most common reason is a larger than average cup-to-disc ratio (the proportion of the optic nerve head occupied by the central cup). A ratio above 0.5, or a difference of 20 percent or more between the two eyes, warrants closer monitoring. Other reasons include borderline eye pressures or a strong family history of glaucoma.

This does not mean you have glaucoma. It means your doctor wants a baseline record to compare against over time. If the optic nerve or visual field changes, that change can be detected early and treatment started before significant vision is lost.

Most glaucoma suspects are asked to return for annual or biannual testing. Once several years of stable results have been recorded, the interval between visits may be extended.

Note: The value of being labelled a glaucoma suspect is that it keeps you in the system. Early detection is the single most powerful tool for preventing glaucoma blindness.

SECONDARY GLAUCOMA

Q6. What is secondary glaucoma, and what causes it?

Secondary glaucoma is glaucoma caused by another identifiable condition or event, rather than arising on its own. It is managed in the same way as primary glaucoma (eye drops, laser, or surgery), but the underlying cause must also be addressed.

The most common secondary types of glaucoma include:

Pseudoexfoliation glaucoma: A protein-like material deposits on the lens and drainage structures of the eye, blocking outflow. This is one of the most common secondary glaucomas in India and tends to cause higher pressures and faster progression than primary open-angle glaucoma. It requires close monitoring and often more aggressive treatment.
Pigmentary glaucoma: Pigment granules shed from the back of the iris clog the drainage angle. It typically affects younger, myopic (short-sighted) patients and is often missed because these patients are not in the standard high-risk age group for glaucoma screening.
Steroid-induced glaucoma: Long-term use of steroid eye drops, nasal sprays, skin creams, or oral steroids can raise eye pressure in susceptible individuals. If you are on any form of steroid medication for any condition, ask your doctor whether your eye pressure has been checked.
Traumatic glaucoma: An injury to the eye can damage the drainage angle and cause pressure to rise, sometimes years after the original injury. Any history of significant eye trauma should be disclosed to your eye doctor.
Neovascular glaucoma: New, abnormal blood vessels grow over the drainage angle, blocking outflow. It is most commonly associated with poorly controlled diabetes and retinal vein occlusion. It is one of the more difficult types to manage and often requires surgery.

Note: If you have a systemic condition such as diabetes, or are on long-term steroid medication, make sure your eye doctor is aware. These are glaucoma risk factors that are often overlooked.

CONGENITAL AND CHILDHOOD GLAUCOMA

Q7. My child has been diagnosed with glaucoma. How is that possible, and what should I expect?

Glaucoma can affect any age group, though it is most common in adults over 40. In children, the most common cause is a structural defect in the drainage angle that is present from birth; this is called congenital glaucoma or primary infantile glaucoma.

Signs that parents typically notice first include:

Cloudy or hazy eyes
Unusual sensitivity to light; the child may turn away from bright light or bury their face
Excessive tearing
Eyes that appear larger than normal (because raised pressure causes the infant eye to expand)

Eye drops may be started initially to control pressure, but surgery is almost always required for congenital glaucoma. Early surgical intervention gives the best chance of preserving good vision throughout the child’s life.

Some children also have a co-existing cataract or other eye abnormality that needs to be managed alongside the glaucoma. Glasses, patching therapy for amblyopia (lazy eye), and follow-up surgeries may all be part of the long-term plan.

Children with glaucoma can lead fully independent lives. Even where some vision has been lost, tailored rehabilitation and visual aids allow children to participate in all age-appropriate activities. As a parent, remaining engaged with the care team and encouraging the child’s independence are the most important things you can do.

Note: Congenital glaucoma is rare. If your child has been diagnosed, seek care from a specialist with specific paediatric glaucoma experience. Early and consistent follow-up is critical.