Discontinuing nasal steroids might lower intraocular pressure in glaucoma

Topical, intraocular, oral, and parenteral steroids might increase intraocular pressure (IOP), but little is known regarding the effect of nasal steroid spray.

We sought to examine the effect of discontinuing nasal steroid sprays on IOP in patients with glaucoma.

A retrospective chart review of patients with glaucoma using nasal steroids was performed. Averaged IOP for each pair of eyes was determined for presteroid use, steroid use, and 2 consecutive poststeroid use (poststeroid 1 and poststeroid 2) examinations.

Twenty-four eyes of 12 patients taking nasal steroids were identified. The mean IOP for each pair of eyes was 15.4 +/- 4.3 mm Hg (range, 9-23.5 mm Hg) for the presteroid use examination, 18.0 +/- 3.8 mm Hg (range, 12-24.5 mm Hg) for the steroid use examination, 14.5 +/- 3.3 mm Hg (range, 9.5-20 mm Hg) for poststeroid use examination 1, and 14.8 +/- 3.4 mm Hg (range, 95-22.0 mm Hg) for poststeroid use examination 2. Eleven patients experienced decreased averaged IOP at poststeroid use examination 1 after steroid discontinuation at a mean of 35 +/- 14 days and continued to maintain this decrease on the poststeroid use examination 2 visit at a mean of 191 +/- 150 days. A significant increase between presteroid and steroid use examination IOPs (P = .007) and a significant decrease between steroid use and both poststeroid use 1 (P < .001) and poststeroid use 2 (P = .011) examination IOPs were observed. No significant difference between presteroid use and either poststeroid use examination IOPs (P = 1.00) was found. Many patients met their target pressures and were able to avoid or delay additional glaucoma therapy.

A significant reduction in IOP occurred with nasal steroid discontinuation in patients with glaucoma. Nasal steroids might contribute to IOP increase, and inquiry as to whether a patient has glaucoma before medication initiation is warranted.