The relationship of intranasal steroids to intraocular pressure

Intranasal corticosteroids have become a gold standard in therapy for allergic rhinoconjunctivitis. A direct relationship between topical and systemic corticosteroids and elevated intraocular pressure (IOP) has been recognized for more than 50 years. However, this steroid-induced response is highly variable. Glaucoma is an eye disease caused by an increase in IOP and results in optic nerve cell death and vision loss. Intranasal corticosteroids are absorbed systemically albeit in small measurable amounts. Some studies suggest a relationship between intranasal steroids and increased IOP. Large prospective studies to determine if there is a significant relationship between intranasal steroids and increased IOP are lacking. We review the current knowledge base regarding intranasal steroid usage and steroid-induced glaucoma.