Visual loss after intranasal corticosteroid injection. Incidence, causes, and prevention

In an attempt to establish accurately the incidence of visual abnormalities that result from an intranasal corticosteroid injection, data were obtained from published and unpublished case reports, pharmaceutical companies, and adverse-reaction reports furnished by the Food and Drug Administration. Only ten instances of visual loss associated with an intranasal steroid injection could be confirmed. Of these ten instances, five were transient and five were permanent. White steroid emboli were demonstrated in the retinal vessels in six cases. Possible factors that contribute to retinal embolization of intranasally injected steroids include a deep or forceful injection, failure to precede and injection with a topical vasoconstrictor, and clumping or precipitation of injected particles contributing to embolization.