Abstract Background/purpose Identify the prevalence and risk factors for secondary glaucoma among Mexican-mestizo patients with Vogt-Koyanagi-Harada Disease (VKH). Methods Retrospective cohort study analyzing the demographic, clinical, and epidemiological variables. Risk estimates were calculated using a Cox proportional hazards regression model. Results One hundred eyes of 50 patients, 44 (88%) women and 6 men (12%) with a median age of 35.5 years (IQR 29–46) and a median follow-up time of 72 months (IQR 13.7–126.7) were analyzed. The prevalence of glaucoma was 20%, with angle-closure accounting for 70% of all cases. Significant clinical risk factors for glaucoma development were a chronic recurrent stage at presentation (RR 2.88, 95% CI 1.11–12.63, p = 0.037), ≥ 2 episodes of recurrent anterior uveitis (RR 8.52, 95% CI 2.02–35.92, p < 0.001), angle-closure disease (ACD, RR 7.08, 95% CI 2.44–20.48, p < 0.001), iris bombé (RR 5.0, 95% CI 2.10–11.90, p < 0.001), and peripapillary atrophy (RR 3.56, 95% CI 1.43–8.85, p < 0.001). Exposure to > 24 months of oral (RR 9.33, 95% CI 2.21–39.28, p < 0.001) or > 12 months of topical corticosteroids (RR 3.88, 95% CI 1.31–11.46, p = 0.007) were associated with an increased likelihood for secondary glaucoma development. Conclusion Glaucoma is a frequent complication of VKH, often attributed to mixed pathogenic mechanisms. Chronic disease at presentation, recurrent inflammation, angle-closure mechanisms, iris bombé, and peripapillary atrophy represent clinically significant risk factors for developing secondary glaucoma. Prompt and aggressive steroid-spearing immunosuppressive therapy for adequate inflammation control may lower the risk of glaucoma in VKH.