INCS Use for Rhinitis Not Associated with Cataracts, Intraocular Pressure

Does the use of intranasal corticosteroids (INCS) lead to increased intraocular pressure (IOP) above 20 mm Hg, glaucoma, or formation of posterior subcapsular cataracts in adult patients with rhinitis?

Bottom Line:
INCS use 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.

Background: Although the safety and efficacy of INCS are well established, there remains a concern that its use can lead to systemic side effects as seen with oral steroid administration, including the risk of posterior subcapsular cataracts or open-angle glaucoma. There have been no meta-analyses conducted on ocular changes, and only a handful of review articles discuss the use of INCS and ocular changes.

Study design: Literature review of 10 randomized controlled trials.

Setting: Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases.

Synopsis: Four of the studies were useable for meta-analysis. Overall, risk of bias ranged from low to unclear for the majority of the domains across the included studies, and the patient population included patients older than 18 years of age, except for two studies, which included adolescents. All patients had a diagnosis of rhinitis. There were no patients with preexisting glaucoma or with evidence of posterior subcapsular cataract formation prior to INCS use except for two patients in one study who had posterior subcapsular cataracts at baseline that were initially missed. There were only two studies that assessed ocular changes with first generation INCS (beclomethasone); the majority mentioned use of tonometry to assess IOPs, but the exact tools varied. The absolute increased incidence of elevated IOP in patients using INCS was 0.8%. The overall incidence of glaucoma was 0/2,837. The absolute increased incidence of patients developing a posterior subcapsular cataract while using INCS versus placebo was not significant. In the meta-analysis, there were no patients with preexisting glaucoma. In total, the overall sample size was 2,226 patients, with 1,587 receiving the study drug and 639 receiving a placebo. All studies shared a follow-up period at 52 weeks. The overall pooled relative risk of abnormally elevated IOP in those who received INCS was 2.24 compared to those who received placebo. This study is limited in its generalizability.

Citation: Valenzuela, CV, Liu JC, Vila PM, Simon L, Doering M, Lieu JEC. Intranasal corticosteroids do not lead to ocular changes: a systematic review and meta-analysis. Laryngoscope. Published September 19, 2018 online ahead of print. doi: 10.1002/lary.27209