A study of intranasal steroids on changes in intraocular pressure in patients with upper respiratory tract diseases at Bangplee Hospital
Keywords:intranasal steroids, intraocular pressure, Fluticasone furoate
In recent years, Samutprakan province has developed into an industrial zone. As a result, Bangplee Hospital has seen an increasing number of patients suffering from upper respiratory tract problems. Intranasal steroids have been shown to be an effective treatment for the aforementioned diseases and their usage has been on the rise due to the chronic nature of these diseases. Therefore, the possibly adverse effects of intranasal steroids should be considered. However, the effect of intranasal steroids on intraocular pressure remains less well-defined. Therefore, the objective of this study was to study the effect of intranasal steroids on intraocular pressure in patients with upper respiratory tract diseases at Bangplee Hospital. A before-and- after observational study was conducted with 62 patients at Bangplee Hospital from March to November 2020. The age range was between 18-70 years old. The patients were diagnosed with allergic rhinitis, non-allergic rhinitis, chronic rhinosinusitis or nasal polyps and used intranasal steroids (Fluticasone furoate) to treat their symptoms. All patients had normal intraocular pressures (< 21 mmHg) and did not have cataracts or glaucoma. The intraocular pressure of each eye was measured before the intranasal treatment and repeated one, three and six months after treatment. The obtained intraocular pressure data, as a dependent variable, were analyzed using repeated measures ANOVA as a function of the duration of intranasal steroid use (independent variable). The mean intraocular pressure was 14.46±2.49 mmHg for pre-steroid treatment, 14.27±2.39 mmHg, 14.37±2.29 mmHg and 14.65±2.39 mmHg for one month, three months and six months of steroid treatment, respectively. The repeated measures ANOVA showed no statistically significant difference between the pre-and-post steroid use intraocular pressures at all three treatment time periods (one, three and six months), p-value =0.221. The prolonged use, up to six months, of normal dosage intranasal steroids can be considered safe for patients between 18-70 years old, with normal intraocular pressure. The drugs used in this study, Fluticasone furoate, did not show risks in elevating intraocular pressure.
2. Rudmik L, Hoy M, Schlosser RJ, et al. Topical therapies in the management of chronic rhinosinusitis. Int Forum Allergy Rhinology 2013;3:281-98.
3. Garbe E, Lelorier J, Boivin J, et al. Inhaled and nasal corticosteroids and the risk of ocular hypertension or open-angle glaucoma. JAMA 1997;277:722-7.
4. Garbe E, Lelorier J, Boivin J, et al. Risk of ocular hypertension or open-angle glaucoma in elderly patients on oral glucocorticoids Lancet 1997;350:979-82.
5. Bui CM, Chen H, Shyr Y, Joos KM. Discontinuing nasal steroids might lower intraocular pressure in glaucoma. J Allergy Clin Immunol 2005;116:1042-7.
6. Opatowsky I, Feldman RM, Gross R, et al. Intraocular pressure elevation associated with inhalation and nasal corticosteroids. Opthalmology 1995;102:177-9.
7. Fraunfelder F, Meyer S. Posterior subcapsular cataracts associated with nasal or inhalation corticosteroids. Am J Opthalmology 1990;109:489-90.
8. Liu A, Manche EE. Bilateral posterior subcapsular cataracts associated with long term intranasal steroid use. J Cataract Refract Surg 2011;37:1555-8.
9. Nazanin A, Kornkiat S, Larry K, et al. Intranasal corticosteroids do not affect intraocular pressure or lens opacity: a systematic review of controlled trials. Rhinology 2015;53:290-302.
10. Bamroong P, Jarumalai C, Aeumjaturapat S. Effect of intranasal corticosteroids on intraocular pressure. Thai J Otolaryngol Head Neck Surg 2010;11:147-54.
11. Bamroong P. Effect of intranasal corticosteroids on intraocular pressure in case allergic rhinitis of Mukdahan hospital. Yasothon Medical Journal 2016;18:49-55.
12. H. Derendorf, E.O. Meltzer. Molecular and clinical pharmacology of intranasal corticosteroids: clinical and therapeutic implications. Allergy 2008;63:1292-300.
13. Benninger MS, Ahmed N, Marple BE. The safety of intranasal steroids. Otolaryngol Head Neck Surg 2003;129:739-50.