pulmicort and Ocular-Hypertension

Intranasal and oral corticosteroids are widely used in the management of chronic rhinosinusitis with nasal polyps (CRSwNP). Higher-dose topical nasal steroids (HDTNS) such as budesonide irrigations are increasingly used for long-term maintenance in these patients. Oral steroids have the potential to cause increased intraocular pressure (IOP) and glaucoma. It is unclear whether HDTNS have the same potential. The objective of this study was to determine the effect of intranasal budesonide irrigations on IOP.. Two groups of patients with CRSwNP treated with budesonide irrigations were prospectively enrolled. Patients with history of elevated IOP or glaucoma were excluded. Patients in group 1 had been using budesonide for at least 1 month and had IOP measured once at the time of enrollment. Group 2 consisted of patients who were placed on budesonide at the time of enrollment and had IOP measured both before and after at least 4 weeks of therapy.. Ten patients in group 1 and 8 patients in group 2 completed the study. In group 1, the average duration of therapy at enrollment was 6.3 months (1-22 months). Only 1 patient had a single eye pressure above 21 mmHg. None of the patients in group 2 had a significant change in IOP or IOP over 21 mmHg.. Intranasal budesonide irrigations given for a period of at least 1 month do not appear to increase IOP.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Budesonide; Chronic Disease; Female; Follow-Up Studies; Glaucoma; Humans; Male; Middle Aged; Nasal Polyps; Ocular Hypertension; Prospective Studies; Rhinitis; Sinusitis; Therapeutic Irrigation; Young Adult

Inhalation steroid therapy can cause ocular hypertension or open angle glaucoma. The authors describe the case of a young girl who presented with raised intraocular pressure and headaches due to the prolonged administration of nasal and inhalation steroids. The ophthalmologist should monitor the intraocular pressure in patients who use inhalation or nasal steroid therapy on a regular base. The physician or paediatrician should be aware of this complication in children with headaches or diminished visual acuity.

Topics: Administration, Inhalation; Asthma; Budesonide; Child; Female; Headache; Humans; Intraocular Pressure; Ocular Hypertension

It is possible that corticosteroids administered via nasal spray might reach ocular structures in levels sufficient to provoke an ocular hypertensive response and cause posterior subcapsular cataracts (PSCs) in susceptible individuals. In the present study, 26 patients who had undergone endoscopic sinus surgery were evaluated prospectively with respect to intraocular pressure and PSC formation following the use of nasal steroids for at least three months. Eighteen patients (69%) self-administered 200 micrograms/day of budesonide nasal spray twice daily, and eight patients (31%) self-administered 200 micrograms/day of beclomethasone dipropionate nasal spray twice daily, for a period of three to 19 months (mean 8.8 +/- 3.6 months). Ophthalmologic examination, tonometry, visual field testing and biomicroscopic studies revealed no evidence of ocular hypertension or PSCs during postoperative follow-up. We conclude that intranasal corticosteroids can be used safely for prolonged periods without increasing the risk of ocular hypertension or PSCs.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Beclomethasone; Budesonide; Cataract; Cataract Extraction; Female; Humans; Intraocular Pressure; Male; Middle Aged; Ocular Hypertension; Retrospective Studies; Time Factors