Corticosteroid Exposure Increases Intraocular Pressure, But Not Glaucoma Risk

Woman using inhaler
Mature woman using asthma inhaler.
The asthma treatment is not associated with glaucoma or ocular hypertension risk, according to a study.

The use of inhaled corticosteroids (ICS) and intranasal corticosteroids (INS) are correlated with increased intraocular pressures (IOP) compared with controls, according to research published in Clinical Ophthalmology. However, the research shows no correlation with rates of glaucoma or ocular hypertension (OHT), the study says. 

In 2019, the Global Initiative for Asthma recommended ICS and INS treatment as part of reliever combination therapy in asthma patients at least 12 years of age. However, chronic steroid use is a known risk factor for increased IOP and, potentially, glaucoma.

The researchers conducted a systematic review of the literature surrounding the relationship between glaucoma outcomes and the use of ICS and INS. The studies were categorized as qualitative or quantitative, or both, based on their methodology. 

In all, they analyzed 65 studies qualitatively and 41 quantitatively. 536,412 participants aged 0 to 97 years old were included and the follow-up period ranged from 1 week to 2 years. 

The study shows no correlation between ICS or INS use and the incidence of glaucoma or OHT. The researchers did note a mean difference of +0.69 mm Hg (95% CI: 0.15, 1.23; P <.01) when comparing the IOPs of participants who used ICS or INS (n=857) and controls (n=615). The investigation also found no significant differences between pre- and post-treatment IOP levels in patients treated with ICS or INS. 

“Overall lack of significant increases in glaucoma or OHT incidence suggests that the use of INS and ICS at the doses prescribed and over the periods studied are, alone, not a major risk factor,” researchers say. However, they do suggest considering the risk factors of ICS and INS use on a patient-by-patient basis.

The limitations of the studies used in this meta-analysis include exclusion of participants with a family history of glaucoma, variability in diagnostic methods, a lack of IOP reporting in the literature, and the influence of industry sponsorships on individual studies. 

Reference

Vinokurtseva A, Fung M ,Li EA, Zhang R, Armstrong JJ, Hutnik C. Impact of inhaled and intranasal corticosteroids exposure on the risk of ocular hypertension and glaucoma: a systematic review and meta-analysisClin Ophthalmol. 2022;16:1675-1695. doi:10.2147/OPTH.S358066