Sniffing Out the Risks: Ophthalmic Complications of Intranasal Corticosteroids
Dr Lauren Byrnes, Senior House Officer, Darling Downs Health, Toowoomba, Australia
Authors List
Byrnes, L., Morrissey, D., ENT Department, Darling Downs Health, Toowoomba, Australia
Introduction: Intranasal corticosteroids (INCS) are the first-line treatment for allergic rhinitis and chronic rhinosinusitis due to their potent anti-inflammatory effects. However, corticosteroids are known to cause ocular side effects when used systemically or topically. While INCS have minimal systemic absorption, concerns exist regarding their potential impact on intraocular pressure (IOP), glaucoma, and cataract formation. This presentation examines current evidence on INCS-related ophthalmic risks and provides practical guidance for ENT specialists.
Aim: This review aims to inform and educate Otolaryngologists about the risks of ophthalmic complications from intranasal corticosteroid use.
Methods: A literature review was conducted to evaluate the association between INCS use and ophthalmic complications. Studies published within the last five years were prioritized, with older high-impact articles included where relevant.
Results: The majority of studies suggest that INCS do not significantly increase the risk of glaucoma or cataracts in the general population. However, in steroid-sensitive individuals, prolonged use may lead to elevated IOP. Patients with pre-existing ocular hypertension or a family history of glaucoma may be at higher risk and require ophthalmologic monitoring. Additionally, case reports have documented rare complications such as retinal embolization from improper spray technique.
Conclusions: While INCS are generally safe, ENT specialists should be aware of potential ocular risks, especially in at-risk populations. Educating patients on proper administration techniques—such as directing the spray laterally rather than toward the nasal septum—can minimize complications. Collaboration with ophthalmologists is recommended for patients with predisposing ocular conditions to ensure safe long-term use.
References
1. Eren E, Arslan U, Erdurmus M, et al. Intranasal corticosteroids do not lead to ocular changes: a systematic review and meta-analysis. Laryngoscope. 2019;129(1):6-12. 2. Roth M, Zhong J, Zumbrunn T, et al. Ocular effects of inhaled and intranasal corticosteroids: systematic review and meta-analysis. J Clin Med. 2022;11(7):2007.
Byrnes, L., Morrissey, D., ENT Department, Darling Downs Health, Toowoomba, Australia
Introduction: Intranasal corticosteroids (INCS) are the first-line treatment for allergic rhinitis and chronic rhinosinusitis due to their potent anti-inflammatory effects. However, corticosteroids are known to cause ocular side effects when used systemically or topically. While INCS have minimal systemic absorption, concerns exist regarding their potential impact on intraocular pressure (IOP), glaucoma, and cataract formation. This presentation examines current evidence on INCS-related ophthalmic risks and provides practical guidance for ENT specialists.
Aim: This review aims to inform and educate Otolaryngologists about the risks of ophthalmic complications from intranasal corticosteroid use.
Methods: A literature review was conducted to evaluate the association between INCS use and ophthalmic complications. Studies published within the last five years were prioritized, with older high-impact articles included where relevant.
Results: The majority of studies suggest that INCS do not significantly increase the risk of glaucoma or cataracts in the general population. However, in steroid-sensitive individuals, prolonged use may lead to elevated IOP. Patients with pre-existing ocular hypertension or a family history of glaucoma may be at higher risk and require ophthalmologic monitoring. Additionally, case reports have documented rare complications such as retinal embolization from improper spray technique.
Conclusions: While INCS are generally safe, ENT specialists should be aware of potential ocular risks, especially in at-risk populations. Educating patients on proper administration techniques—such as directing the spray laterally rather than toward the nasal septum—can minimize complications. Collaboration with ophthalmologists is recommended for patients with predisposing ocular conditions to ensure safe long-term use.
References
1. Eren E, Arslan U, Erdurmus M, et al. Intranasal corticosteroids do not lead to ocular changes: a systematic review and meta-analysis. Laryngoscope. 2019;129(1):6-12. 2. Roth M, Zhong J, Zumbrunn T, et al. Ocular effects of inhaled and intranasal corticosteroids: systematic review and meta-analysis. J Clin Med. 2022;11(7):2007.
