Prolonged use of intranasal steroids for allergic rhinitis can cause a significant increase in intraocular pressure (IOP), according to a study in the Journal of Glaucoma.

In this observational cross-sectional study set in a tertiary referral center, a team of Malaysian researchers enrolled 100 eyes from 50 patients who were on a long-term intranasal steroid regimen for more than two years to treat allergic rhinitis. They excluded patients taking other steroids and who had glaucoma risk factors. They also included a control group of 90 eyes from 45 patients. Investigators measured IOP and took non-mydriatic stereoscopic optic disc photos for each eye. Additionally, they evaluated vertical cup-to-disc ratio and the status of the optic disc in each patient.

The majority of patients, 78%, used mometasone furoate, followed by fluticasone furoate (12%) and beclomethasone dipropionate (10%). Once-daily dosing was the norm at 80% of patients.

Researchers found the mean IOP for the intranasal steroid group was significantly higher (15.24 ±2.31mm Hg) compared with the control group (13.91 ±1.86mm Hg). However, they noted there were no significant differences in the vertical cup-to-disc ratio and the status of glaucomatous optic disc changes between the two.

“Our groups of patients are fairly young and more susceptible to steroid responsiveness. However, none of our patients have any family history of glaucoma. We found significantly higher IOP in these patients compared to their age-matched controls although this increased IOP still falls within the normal range and was not sufficient to cause significant glaucomatous optic disc changes between the two groups,” the researchers said in their paper.

Investigators noted the mean IOP in patients receiving fluticasone was highest compared with the two other types of intranasal steroids, although it was not statistically significant, possibly because of the small number of patients in each group.

“Prolonged use of intranasal steroids cause statistical significant increase in IOP in patients with allergic rhinitis although no significant glaucomatous disc changes were seen,” the authors wrote. “We suggest patients on long-term use of intranasal steroid have a yearly eye examination to be monitored for IOP elevation and those with additional risk factors for glaucoma is closely monitored for glaucoma.” 

Mohd Zain A, KalthumMd Noh U, Hussein S, et al. The relationship between long-term use of intranasal corticosteroid and intraocular pressure. J Glaucoma. December 24, 2018. [Epub ahead of print].