This excellent, high quality and detailed systematic review from Australia dispels the myth propagated recently by some poorly designed studies that intranasal corticosteroids cause intraocular problems. A 40 year review of the usual databases found 665 articles and 19 were selected for this systematic review. Ten were RCTs with several thousand patients reported on in total. The articles variably reported outcomes of lens opacity / cataract formation, intraocular pressure measurements and glaucoma change, in patients including children using intranasal corticosteroids for proven allergic rhinitis and using no other form of steroid administration. Follow-up was up to two years. Various different intranasal corticosteroids had been used over this time period.
This review found no difference in intraocular pressure or diagnosis of glaucoma in over 4000 patients in 10 RCTs treated with INCS.
Furthermore five studies showed that intraocular hypertension and glaucoma were not worsened by INCS and finally no difference in lens opacity or new diagnosis of cataract in 3000 patients across six RCTs. Modern intranasal corticosteroids are slow release lipophilic compounds, 30% of the administered dose remains in the nose, with a high degree of glucocorticoid receptor affinity, low systematic bioavailability and the remainder swallowed is subject to first pass hepatic metabolism. Side-effects of this medication are minimal and there is certainly now quality evidence to demonstrate that they do not cause ocular problems
