Abstract
Abstract: :
Purpose: Systemic steroids may elevate intraocular pressure (IOP), and nasal steroids are being prescribed more commonly for allergic rhinitis. We examined the effects of discontinuing nasal steroid sprays on IOP in patients with glaucoma or ocular hypertension (OHT). Methods: A retrospective chart review of glaucoma and OHT patients with elevated or suboptimal IOP while using nasal steroids was performed after approval by the Vanderbilt Institutional Review Board. The glaucoma diagnosis and the type of steroid nasal spray were noted for each patient. The average IOP for each pair of eyes was determined from each of the pre–steroid, steroid–usage, and post–steroid clinical examinations. Data were analyzed with a Friedman Repeated Measures ANOVA on Ranks, and Tukey Pairwise Multiple Comparison Procedure. Results:13 patients (12 glaucoma, 1 OHT) were identified with an elevation of IOP while using nasal steroids. No patient realized that the nasal sprays were steroids, and 2 patients were known systemic steroid–responders. The mean IOP for each pair of eyes were calculated from the pre–steroid (14.5+4.5 mmHg, range 9–23.5 mmHg), steroid–usage (17.5+5.2 mmHg, range 12–30 mmHg), and post–steroid (13.8+3.2 mmHg, range 9.5–20 mmHg) examinations. Twenty–one of the 26 eyes had a decreased IOP after discontinuation of the nasal steroids for a mean of 42±26 days. The mean percent decline of the averaged IOP of both eyes of each patient was 19+13% (range –4 to 47%). There was a significant difference in averaged IOP of both eyes among the 3 time points (p=0.002), with a significant increase between pre–steroid IOP and steroid–usage IOP (p<0.05), as well as a significant decrease between steroid–usage IOP and post–steroid IOP (p<0.05). There was no significant difference between pre–steroid IOP and post–steroid IOP (p>0.05). All patients were able to avoid or delay additional medical or surgical therapy. Conclusions: A clinically and statistically significant reduction in IOP may be achieved with discontinuation of steroid nasal spray in patients with glaucoma or OHT. Nasal steroids may contribute to IOP elevation and warrant inquiry about their usage in patients with glaucoma or OHT who may be unaware that their nasal spray is a steroid.
Keywords: intraocular pressure • drug toxicity/drug effects • clinical (human) or epidemiologic studies: outcomes/complications