Study Examines the Connection Between Inhaled Steroids and Glaucoma
People living with chronic obstructive pulmonary disease (COPD) may rely on inhaled medications for years to manage breathing difficulties. However, long-term medication use can raise questions about possible effects on other parts of the body, including the eyes.
A large study published in October 2026 investigated whether prolonged exposure to inhaled corticosteroids could increase the likelihood of developing open-angle glaucoma. The findings offer some reassurance, although researchers emphasize that a possible risk cannot be completely excluded.
The research examined 84,564 patients with COPD and found no statistically significant overall increase in open-angle glaucoma associated with inhaled corticosteroid use, including among patients with higher cumulative exposure and longer treatment periods.
What Did the Glaucoma Research Discover?
The research, titled Long-Term Inhaled Corticosteroid Use and the Risk of Open-Angle Glaucoma in Patients with Chronic Obstructive Pulmonary Disease, was published in the International Journal of Chronic Obstructive Pulmonary Disease on October 15, 2026.
The study was conducted by researchers affiliated with institutions in Canada and France. The authors included Inès Ben Ghezala, Sophie Dell’Aniello, Pierre Ernst, and Samy Suissa.
The researchers wanted to determine whether inhaled corticosteroids (ICS), commonly used in COPD management, were associated with an increased risk of developing open-angle glaucoma over an extended period.
Earlier research had produced mixed findings, particularly concerning short-term exposure. The authors identified a need to investigate cumulative medication exposure over several years rather than focusing only on recent prescriptions.
The study therefore examined three important questions:
- Whether patients using inhaled corticosteroids were more likely to develop open-angle glaucoma than non-users.
- Whether higher cumulative medication exposure was associated with increased glaucoma risk.
- Whether using inhaled corticosteroids for longer periods was linked to a greater likelihood of developing the condition.
How the Researchers Conducted the Study
The research used medical records from the United Kingdom’s Clinical Practice Research Datalink (CPRD), a large database containing information from primary healthcare practices.
The researchers identified patients diagnosed with COPD who were at least 40 years old and had started inhaled maintenance treatment between September 2013 and March 2021.
Patients with a previous glaucoma diagnosis or certain early indicators of the condition were excluded when establishing the study cohort. This allowed researchers to investigate newly diagnosed open-angle glaucoma during follow-up.
The final cohort included 84,564 individuals. Researchers followed their medical records and examined the relationship between inhaled corticosteroid exposure and subsequent glaucoma diagnoses.
Among these participants, 732 developed open-angle glaucoma. Approximately 56% had used inhaled corticosteroids during the observation period.
The study accumulated 277,655 person-years of follow-up, with an overall open-angle glaucoma incidence rate of 2.64 cases per 1,000 person-years.
Did Long-Term Corticosteroid Use Increase Glaucoma Risk?
The main findings did not establish a statistically significant association between inhaled corticosteroid exposure and newly diagnosed open-angle glaucoma.
Researchers calculated an adjusted hazard ratio (HR) of 1.14 for patients who had used inhaled corticosteroids compared with those who had not. The 95% confidence interval was 0.94–1.38.
Because this confidence interval includes 1.00, the overall result does not demonstrate a statistically significant increase in glaucoma risk.
The findings remained similar when researchers examined cumulative exposure and treatment duration separately.
Higher Cumulative Medication Exposure
The research examined whether patients receiving a cumulative inhaled corticosteroid dose of at least 365 milligrams had a greater likelihood of developing glaucoma.
The adjusted hazard ratio for this higher cumulative exposure group was 1.11, with a 95% confidence interval of 0.83–1.48.
For patients with cumulative exposure below 365 milligrams, the corresponding hazard ratio was 1.15, with a 95% confidence interval of 0.95–1.39.
Neither result demonstrated a statistically significant increase in open-angle glaucoma risk.
The researchers also examined cumulative exposure using statistical models and found no clear dose-response relationship.
Duration of Inhaled Corticosteroid Use
Another important part of the investigation involved comparing patients according to how long they had used inhaled corticosteroids.
The results were as follows:
- Less than one year: HR 1.11 (95% CI, 0.86–1.45).
- One to three years: HR 1.12 (95% CI, 0.88–1.42).
- More than three years: HR 1.23 (95% CI, 0.90–1.68).
Although the estimated hazard ratio was higher among patients treated for more than three years, the confidence interval included 1.00. Consequently, the findings did not establish a statistically significant duration-related increase in risk.
The researchers also found no clear evidence of a duration-response relationship during the first seven years following the initial inhaled corticosteroid prescription.
Researchers Identify an Age-Related Finding
Although the overall results were reassuring, an exploratory subgroup analysis identified a potentially important finding involving patients aged 70 to 74 years.
In this age group, the adjusted hazard ratio was 1.49, with a 95% confidence interval of 1.07–2.07. This represented a higher estimated risk compared with the corresponding non-user group.
However, the finding requires careful interpretation. It came from an exploratory subgroup analysis involving multiple comparisons, and the researchers cautioned that the result could reflect random variation.
For comparison, the estimated hazard ratio was 1.01 (95% CI, 0.76–1.35) among patients younger than 70 years.
Among those aged 75 years and older, the estimate was 1.07 (95% CI, 0.82–1.39).
The study therefore did not establish a consistent age-related pattern across all older participants. The researchers indicated that additional investigations involving larger numbers of glaucoma cases would help clarify this finding.
Understanding How Corticosteroids May Affect the Eyes
Corticosteroids are medications used to reduce inflammation in different parts of the body. Depending on the medical condition, they may be administered through inhalers, eye drops, nasal sprays, tablets, or other formulations.
Although corticosteroids can be beneficial for treating inflammatory conditions, certain forms of exposure may influence intraocular pressure (IOP), the pressure inside the eye.
In susceptible individuals, corticosteroid exposure can interfere with the normal drainage of aqueous humor, the clear fluid circulating inside the front portion of the eye.
When fluid drainage becomes less efficient, pressure inside the eye may increase. Sustained elevation of intraocular pressure is an important risk factor for glaucoma, although some people develop glaucoma without elevated pressure.
What Is Open-Angle Glaucoma?
Open-angle glaucoma is a progressive eye disease involving damage to the optic nerve, which carries visual information from the retina to the brain.
The condition commonly develops gradually. Many people experience no noticeable symptoms during its early stages, making regular eye examinations particularly important.
As the disease progresses, it can cause peripheral vision loss. Without appropriate monitoring and management, damage may eventually affect central vision.
Because early glaucoma can be difficult to recognize without an examination, measuring eye pressure and assessing the optic nerve are important parts of routine eye care.
Why the Study’s Findings Matter for COPD Patients
COPD is a long-term respiratory condition that can cause persistent breathing difficulties, coughing, and reduced airflow. Inhaled maintenance treatments are used to help control symptoms and reduce the frequency of exacerbations in appropriate patients.
For people who depend on these medications, concerns about possible eye complications can create uncertainty about continuing treatment.
The research provides useful information because it examined cumulative inhaled corticosteroid exposure across a large population rather than relying exclusively on short-term observations.
However, the findings should not be interpreted as proof that inhaled corticosteroids are completely free of eye-related risks.
The study was observational, meaning researchers examined existing medical records rather than randomly assigning participants to different medication treatments. Other health conditions and unmeasured risk factors could therefore influence the results.
The authors also acknowledged that the average follow-up period was 2.5 years, which may be insufficient to capture every case of a slowly progressing condition such as glaucoma.
Furthermore, the number of confirmed glaucoma cases was relatively small compared with the overall cohort, potentially limiting the statistical power of certain analyses.
Eye Examinations and Tests That Help Detect Glaucoma
People concerned about glaucoma can discuss appropriate screening with an optometrist or ophthalmologist. Eye examinations can identify pressure changes and signs of optic nerve damage before substantial vision loss occurs.
Depending on individual circumstances, an eye care professional may recommend several assessments.
Tonometry
Tonometry measures intraocular pressure. It helps identify elevated eye pressure, an important glaucoma risk factor, although a normal result does not completely exclude the disease.
Optic Nerve Examination
An eye care professional examines the optic nerve to look for structural changes associated with glaucoma. Optical coherence tomography (OCT) can provide detailed images of retinal nerve fiber layers and other relevant structures.
Visual Field Testing
A visual field test evaluates peripheral vision and helps identify areas where vision may have been lost. It is particularly useful for monitoring changes associated with glaucoma progression.
Gonioscopy
Gonioscopy allows an eye specialist to examine the drainage angle inside the eye. This helps distinguish different types of glaucoma and assess whether the drainage pathway is open or restricted.
When Should You See an Eye Doctor?
People using long-term corticosteroid medication should discuss their eye health with an appropriate healthcare professional, particularly if they have additional glaucoma risk factors.
Arrange an eye examination if you experience persistent blurred vision, unexplained changes in peripheral vision, or other unusual visual symptoms.
Seek urgent medical attention if you develop sudden severe eye pain, a red eye, blurred vision, halos around lights, headache, or nausea. These symptoms can indicate acute angle-closure glaucoma or another serious eye condition requiring immediate assessment.
Do not stop prescribed inhaled corticosteroids or change your respiratory treatment without consulting the clinician managing your COPD.
Frequently Asked Questions
1. Does long-term inhaled corticosteroid use cause glaucoma?
The October 2026 study did not find a statistically significant overall increase in open-angle glaucoma risk among COPD patients using inhaled corticosteroids, including those with longer treatment durations and higher cumulative exposure. However, a possible modest risk cannot be completely excluded.
2. Which age group showed a potentially higher glaucoma risk?
The exploratory analysis identified a higher estimated risk among patients aged 70 to 74 years, with an adjusted hazard ratio of 1.49 (95% CI, 1.07–2.07). The authors cautioned that this finding requires further investigation.
3. Should COPD patients stop using inhaled corticosteroids because of glaucoma concerns?
No. The findings do not provide a reason to independently discontinue prescribed respiratory medication. Patients should discuss individual risks and appropriate eye monitoring with their treating healthcare professionals.
What Patients Should Take Away From the Research
The study published in the International Journal of Chronic Obstructive Pulmonary Disease provides useful evidence about the relationship between long-term inhaled corticosteroid exposure and open-angle glaucoma in people with COPD.
Its findings did not demonstrate a statistically significant overall increase in glaucoma risk, even among participants with higher cumulative exposure or more than three years of treatment.
Nevertheless, the exploratory finding involving patients aged 70 to 74 years and the limitations of observational research mean that continued attention to eye health remains important.
If you have COPD and regularly use inhaled maintenance medication, consider discussing your glaucoma risk factors and appropriate examination schedule at your next medical appointment. Maintaining both respiratory health and regular eye care is a practical way to protect your long-term wellbeing.
