Nasal Steroids in Controlled Glaucoma
Nasal Steroids in Controlled Glaucoma
Patients that have consented to participate in the study will be randomly assigned to one of
 two groups: control group or nasal steroid group. Patients in the control group will receive
 normal saline inhaler. Patients in the study group will receive steroid inhaler Follow-up
 visits are: baseline and weeks 2, 4, 6 after starting the spray. Intraocular pressure will be
 recorded on all visits.
Systemic and topical ophthalmic steroids have long been associated with ocular effects, such
 as glaucoma or cataracts. Periocular steroid injections and steroids applied to periocular
 skin have also been reported to increase intraocular pressure (IOP) and raised IOP is the
 major risk factor for glaucoma. Approximately 18 to 36% of the general population are
 corticosteroid responders. This response is increased to 46 to 92% in patients with primary
 open-angle glaucoma (POAG).

 Allergic rhinitis affects up to 30% of adults and 40% of children in the United States.
 Topical nasal steroids are the most effective treatment option.Nonallergic rhinitis is a
 common disease that affects approximately 17 million persons in the United States;
 approximately 22 million have a combination of allergic and nonallergic rhinitis.Topical
 nasal steroids have demonstrated efficacy in the treatment of nonallergic rhinitis and are
 considered first-line empiric therapy.With the perceived safety of nasal steroids, their use
 for the treatment of upper respiratory allergy has become more common.However, inhaled and
 nasal steroids might be absorbed systemically. Although the systemic absorption of inhaled
 and nasal steroids has been established, the clinically relevant ocular side effects are
 poorly defined. A large prospective study in 1995 by Samiy et al reported no statistically
 significant increase of IOP in 187 patients without glaucoma taking inhaled steroids for
 various pulmonary conditions. Similarly, a large case-control study in 1997 cases suggested
 that the presence of nasal steroid use in patients with newly diagnosed glaucoma or OHT
 versus nonglaucomatous patients was not statistically significant (odds ratio, 1.02; 95% CI,
 0.59-1.77). However, the number of patients taking continuous high-dose nasal steroids was
 too small for statistical analysis. In 1998, a small prospective study of 26 non-glaucomatous
 patients revealed no evidence of OHT or cataracts after prolonged use of nasal steroids after
 endoscopic sinus surgery (mean follow-up, 8.8 ± 3.6 months; range, 3-19 months). A study of
 61 patients with seasonal allergic rhinitis taking nasal fluticasone for 1 year showed no
 increased risk for glaucoma.However, no information was described regarding their glaucoma
 risk status before steroid use in this study. Six cases of increased IOP associated with
 combined nasal and inhaled steroid use in non-glaucomatous patients have been reported.

 Considering the large number of patients on nasal steroids; It is surprising that no one has
 investigated if nasal steroid use is contraindicated in glaucoma patients.
Inclusion criteria included the following:

 -  age 18 to 85 years inclusive

 -  OHT or mild to moderate POAG with cup-disc ratio of less than 0.8 vertically and mean
 deviation of less than -12.00 dB on Humphrey perimetry

 -  well controlled disease defined by IOP being at target and no visual field or disc
 progression for a minimum of 6 months

 Exclusion criteria included the following:

 -  any form of steroid medication use within the last 6 weeks

 -  previous intra-ocular or refractive surgery

 -  no light perception vision.

 Patients with or without rhinitis (allergic/ non-allergic/ mixed), with rhinitis defined as
 allergies and/ or nasal congestion present for greater than one year, were eligible.