Background <p>Following keratoplasty, the use of steroids is typically necessary to control postoperative inflammation and prevent graft rejection. However, improper management can lead to elevated intraocular pressure (IOP) and glaucoma. In our view, the use of topical steroid eye drops in one eye is unlikely to cause bilateral steroid-induced glaucoma.</p> Case presentation <p>An 18-year-old male with a history of keratoconus in both eyes and deep anterior lamellar keratoplasty (DALK) in the right eye. Postoperatively, the patient was prescribed 0.1% fluorometholone three times daily in the right eye, and elevated IOP was detected in both eyes. After three months of treatment, glaucomatous damage advanced, and anterior segment examination revealed posterior subcapsular cataract in both eyes. IOP remained uncontrolled and a diagnosis of bilateral steroid-induced glaucoma was established. </p> Conclusion <p>Monocular administration of topical steroids may be associated with bilateral steroid-induced glaucoma in susceptible individuals. We need to emphasize the importance of close monitoring and early intervention for patients taking steroid eye drops.</p>