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

Abstract

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, 2018.

Allergic rhinitis

“…The most common INCS adverse effects are local, including nasal irritation, stinging and epistaxis 111 , and can usually be prevented by aiming the spray slightly away from the nasal septum. Long-term INCS use does not damage nasal mucosa or induce glaucoma 112 , and growth effects in children seem to be minimal 78 . Some INCS, such as budesonide, can be safely used during pregnancy at the recommended therapeutic dose after a thorough medical evaluation 113 .…”

Rhinitis 2020: A practice parameter update

“…Case reports of increased ocular pressure from INCS have been published; 369 however, adequately powered, blinded studies have not confirmed this adverse effect. 1,370 A meta-analysis of 10 clinical trials with 2226 patients did not show a significant risk of elevating intraocular pressure or developing a posterior subcapsular cataract in patients with AR using INCS. 371 The most common side effects of INCS are local and include dryness, burning, stinging, blood tinged secretions, and epistaxis.…”

“…1,370 A meta-analysis of 10 clinical trials with 2226 patients did not show a significant risk of elevating intraocular pressure or developing a posterior subcapsular cataract in patients with AR using INCS. 371 The most common side effects of INCS are local and include dryness, burning, stinging, blood tinged secretions, and epistaxis. The incidence of epistaxis ranges from 4% to 8% over short treatment periods (2 to 12 weeks) and can reach 20% in studies carried over a year.…”

“…1,175 Nasal bleeding with long-term use of topical nasal corticosteroids may approach 28%. 370 The epistaxis reported from INCS can be worsened by the use of anticoagulant agents. [372][373][374][375] Septal perforations, although rare, have been reported.…”

A Scholarly Review of the Safety and Efficacy of Intranasal Corticosteroids Preparations in the Treatment of Chronic Rhinosinusitis

“…18 No clinical relevant impact of INCS was found on intraocular pressure (IOP), glaucoma, lens opacity, nor cataract formation in recently published systematic reviews. 19,20 A meta-analysis and systematic review by Donaldson et al of 60 studies concluded that INCS are safe in the adult population. 21 High-volume irrigations.…”