The Effects of Intranasal, Inhaled and Systemic Glucocorticoids on Intraocular Pressure: A Literature Review

Abstract

Topical glucocorticoids are a well-known risk factor of intraocular pressure (IOP) elevation in one third of the general population and in up to 90% of glaucomatous patients. Whether this steroid response is caused by intranasal, inhaled or systemic glucocorticoids, is less known. This study presents an overview of the current literature on the topic, thereby providing guidance on when ophthalmological follow-up is indicated. A literature study was performed in Medline, and 31 studies were included for analysis. Twelve out of fourteen studies discussing intranasal glucocorticoids show no significant association with an elevated IOP. Regarding inhaled glucocorticoids, only three out of twelve studies show a significant association. The observed increase was either small or was only observed in patients treated with high inhaled doses or in patients with a family history of glaucoma. An elevated IOP caused by systemic glucocorticoids is reported by four out of the five included studies, with one study reporting a clear dose–response relationship. This review concludes that a steroid response can be triggered in patients treated with systemic glucocorticoids. Inhaled glucocorticoids may cause a significant IOP elevation when administered in high doses or in patients with a family history of glaucoma. At present, there is no evidence for a clinically significant steroid response caused by intranasally administered glucocorticoids.

Season, weather and intraocular pressure: a monocentric retrospective analysis from 2016 - 2021

“…In our study, these factors contribute to high noise in IOP-measurements in our patient group, especially as we included patients with ocular diseases and not a healthy population. However, we have no reason to assume that the other factors would cause a seasonal IOP variation, which could be clearly demonstrated in our Fourier analysis, except potentially increased use of inhaled glucocorticoids during winter months with possible effects on IOP [52]. Increased use of glucocorticoid eye drops during spring and early summer for treatment of allergic conjunctivitis could also potentially in uence IOP [53].…”

TRPV4 subserves physiological and pathological elevations in intraocular pressure

“…Glucocorticoid implants and eye drops are often prescribed to treat macular edema, corneal transplantation and injury-related in ammation but constitute a double-edged sword, with 30-40% of the patients ('steroid responders') and 90% of POAG patients developing OHT (96-98). GSK101, mechanical strain and steroid treatments steer TM cells toward the contractile myo broblast phenotype (99, 100) that may rescued by targeting the mechanotransducer-Rho signaling axis, as indicated by OHT reversal in DEX-treated patients (101) and mice (51) treated with ROCK and TRPV4 inhibitors. Studies in epithelial cells and neurons indeed implicate glucocorticoid exposure in increased TRPV4 gene expression, tra cking and/or lowering of mechanical thresholds (102)(103)(104)(105).…”

New Concepts in Steroid Glaucoma

“…In a large case-control study of more than 35,000 patients, treatment with high dose or chronic intranasal steroids were associated with a diagnosis of glaucoma or ocular hypertension [29]. Many other studies conclude that intranasal and inhaled steroids do not increase intraocular pressure, but these studies are limited by small sample size, variability in dose and length of use, and exclusion of patients with comorbid POAG [30,31]. Given that not all eyes are steroid responders, the small studies are likely missing steroid responders and limit conclusions that can be drawn.…”