Do Nasal Sprays Cause Glaucoma or Cataracts?

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Steroid nasal sprays are very commonly used by patients to treat sino-nasal allergies.  However, a common concern of some patients as well as their eye doctors is that such nasal sprays may cause or exacerbate glaucoma or cataracts. After all, oral steroids and inhaled steroids (for asthma) is associated with such eye problems due to systemic absorption.

Indeed, there is a constant (but collegial) dispute between ENT and EYE doctors on this risk of cataracts and glaucoma with steroid nasal spray use. Namely, ENT doctors feel it perfectly safe to use while EYE doctors argue differently.

Studies have already shown that there is no systemic absorption of steroids administered via nasal spray at normal use dosages. That's why such steroid nasal sprays are safe to use regularly even in young children. It's safety profile is so good that it's even available over-the-counter. You can even buy them on Amazon!

But what specifically does the evidence say?

Two large studies of patients using nasal sprays found NO association with glaucoma or cataracts. One was a case-control study of more than 9,700 patients and the other study was a retrospective observational study of more than 286,000 patients.

Other corroborating studies listed below under references.

To be fair, however, there are occasional case reports linking glaucoma with steroid nasal sprays. Only one study in particular with a study group of only 12 patients suggested steroid nasal sprays exacerbate glaucoma and stopping use may result in decreased intra-ocular pressure.

But overall, there is overwhelming support that steroid nasal sprays are safe for patients from a glaucoma and cataract perspective. BUT, if a patient has glaucoma that is not being easily controlled, than it may be worthwhile to try stopping the nasal sprays to see if it helps.

As an aside, decongestant nasal sprays have been found to actively REDUCE risk of glaucoma [link]. Too bad it can't be used regularly due to risk of addiction however.

References:
Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta-analysis. Laryngoscope. 2018 Sep 19. doi: 10.1002/lary.27209.

Effect of beclomethasone nasal spray on intraocular pressure in ocular hypertension or controlled glaucoma. J Glaucoma. 2013 Feb;22(2):84-7. doi: 10.1097/IJG.0b013e3182254811.

Effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics. J Otolaryngol. 2006 Feb;35(1):30-5.

Fluticasone propionate: topical or systemic effects? Clin Exp Allergy. 1996 May;26 Suppl 3:18-22.

Discontinuing nasal steroids might lower intraocular pressure in glaucoma. J Allergy Clin Immunol. 2005 Nov;116(5):1042-7. Epub 2005 Oct 3.

Inhaled and nasal glucocorticoids and the risks of ocular hypertension or open-angle glaucoma. JAMA 1997; 277:722-727.

Risk of cataract among users of intranasal corticosteroids. J Allergy Clin Immunol 2000; 105:912-916.

The effect of intranasal fluticasone propionate irrigations on salivary cortisol, intraocular pressure, and posterior subcapsular cataracts in postsurgical chronic rhinosinusitis patients. Int Forum Allergy Rhinol. 2013 Dec;3(12):953-7. doi: 10.1002/alr.21228. Epub 2013 Oct 2.

Ocular safety of fluticasone furoate nasal spray in patients with perennial allergic rhinitis: a 2-year study. Ann Allergy Asthma Immunol. 2013 Jul;111(1):45-50. doi: 10.1016/j.anai.2013.04.013. Epub 2013 May 12.

Evaluation of intraocular pressure and cataract formation following the long-term use of nasal corticosteroids. Ear Nose Throat J. 1998 Oct;77(10):846-8, 850-1.