Can nasal steroids taken for allergies cause eye problems?

Steroids, especially those inhaled through the mouth to control asthma or those taken orally or intravenously for other conditions such as arthritis and emphysema, can cause side effects in the eye, including cataracts and glaucoma. But steroids such as Flonase that are sniffed through the nose appear to be fairly safe for the eye.

A British study of 88,000 patients using nasal steroids and 98,000 taking oral steroids showed that although oral steroids can increase the risk for cataracts (a clouding of the lens in the eye), nasal steroids do not. The researchers reported their findings in the Journal of Allergy and Clinical Immunology in 2000.

As for glaucoma, a buildup of pressure inside the eye, a small study of 12 patients published in the same journal in 2005 by researchers from the Vanderbilt Eye Institute found that patients who already have glaucoma may see their condition worsen with nasal steroids. This is reversible when nasal steroids are discontinued, the authors said.

Dr. Harry Quigley , director of the glaucoma service at the Wilmer Eye Institute at Johns Hopkins University, said this and other studies suggest that doctors who are prescribing nasal steroids for people with allergies or sinusitis should ask whether patients or their close family members have glaucoma before prescribing the drug.

The most common side effects of nasal steroids are a burning sensation in the nose or bleeding, especially if steroids are sprayed directly on the septum, the cartilage-based tissue that divides the two nostrils, said Dr. Ralph Metson , a sinus surgeon at Massachusetts Eye and Ear Infirmary. To avoid these problems, he said, simply spray toward the outside of the nostrils, not toward the septum.

JUDY FOREMAN

E-mail health questions to Foreman@globe.com.