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Meta-Analysis
. 2019 Jan;129(1):6-12.
doi: 10.1002/lary.27209. Epub 2018 Sep 19.

Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta-analysis

Carla V Valenzuela  1 , James C Liu  2 , Peter M Vila  1 , Laura Simon  3 , Michelle Doering  3 , Judith E C Lieu  1
Affiliations
Meta-Analysis

Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta-analysis

Carla V Valenzuela et al. Laryngoscope. 2019 Jan.

Abstract

Objectives: The safety and efficacy of intranasal corticosteroids (INCS) are well established, but there remains apprehension that INCS could lead to systemic side effects, as with oral steroids. The objective of this systematic review was to assess whether the use of INCS lead to increased intraocular pressure (IOP) above 20 mm Hg, glaucoma, or formation of posterior subcapsular cataracts in adult patients with rhinitis.

Methods: Two medical librarians searched the published literature for records discussing the use of "nasal steroids" in "rhinitis" and their effect on "intraocular pressure," "cataracts," or "glaucoma."

Results: A total of 484 studies were identified, and 10 randomized controlled trials met our inclusion criteria. Meta-analysis of 2,226 patients revealed that the relative risk of elevated IOP in those who received INCS was 2.24 (95% confidence interval [CI]: 0.68 to 7.34) compared to placebo. The absolute increased incidence of elevated IOP in patients using INCS compared to placebo was 0.8% (95% CI: 0% to 1.6%). There were zero cases of glaucoma in both placebo and INCS groups at 12 months. The absolute increased incidence of developing a posterior subcapsular cataract was 0.02% (95% CI: -0.3% to 0.4%).

Conclusions: Use of INCS is not associated with a significant risk of elevating IOP or developing a posterior subcapsular cataract in patients with allergic rhinitis. Presence of glaucoma, however, is the real clinical adverse event of concern. There were zero reported cases of glaucoma at 12 months. Future studies should formally evaluate for glaucoma rather than use IOP measures as a surrogate. Laryngoscope, 129:6-12, 2019.

Keywords: Intranasal steroids; cataract formation; glaucoma; intraocular pressure.

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Conflict of interest statement

The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA Flow Diagram
Figure 2
Figure 2
Risk of Bias assessed using the Cochrane Risk of Bias tool. The (+) symbol represents a low risk of bias, the (−) symbol represents a high risk of bias, and the (?) symbol represents an unclear risk of bias.
Figure 3
Figure 3
Meta analysis of randomized controlled trials demonstrating no significant increase in intra ocular pressures. RR, Relative risk; CI, Confidence interval; IOP, intraocular pressure
See this image and copyright information in PMC

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