Steroid Cataracts — SCE Dermatology MCQ

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ModerateDrug ReactionsSteroid CataractsSCE Dermatology

A 45-year-old woman with atopic eczema has developed cataracts. She has used potent topical corticosteroids around her eyes intermittently for years. What type of cataract is associated with topical corticosteroid use?

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Correct answer: A — Posterior subcapsular cataract (PSC) — the characteristic steroid-induced cataract

Topical (and systemic) corticosteroid use is associated with posterior subcapsular cataracts (PSC). PSC affects the posterior lens capsule and causes glare, difficulty reading, and impaired distance vision. Risk correlates with: potency (stronger steroids = higher risk), duration (chronic use), proximity to the eye (periorbital application), and individual susceptibility. This is distinct from atopic cataracts (which are anterior subcapsular). Regular ophthalmological review is recommended for patients using potent topical steroids around the eyes long-term. Topical calcineurin inhibitors (Tacrolimus, Pimecrolimus) are preferred for periorbital eczema as they do not cause cataracts or glaucoma — a key advantage in this anatomical location.

Reference: BAD 2020 AD; Ophthalmology Guidelines