Nasal Steroids in Controlled Glaucoma
Condition: Intraocular Pressure
MeSH terms: Glaucoma
Study type: Interventional

Summary: 
      Patients that have consented to participate in the study will be randomly assigned to one of
      two groups: control group or nasal steroid group. Patients in the control group will receive
      normal saline inhaler. Patients in the study group will receive steroid inhaler Follow-up
      visits are: baseline and weeks 2, 4, 6 after starting the spray. Intraocular pressure will be
      recorded on all visits.
    

Detailed description: 
      Systemic and topical ophthalmic steroids have long been associated with ocular effects, such
      as glaucoma or cataracts. Periocular steroid injections and steroids applied to periocular
      skin have also been reported to increase intraocular pressure (IOP) and raised IOP is the
      major risk factor for glaucoma. Approximately 18 to 36% of the general population are
      corticosteroid responders. This response is increased to 46 to 92% in patients with primary
      open-angle glaucoma (POAG).

      Allergic rhinitis affects up to 30% of adults and 40% of children in the United States.
      Topical nasal steroids are the most effective treatment option.Nonallergic rhinitis is a
      common disease that affects approximately 17 million persons in the United States;
      approximately 22 million have a combination of allergic and nonallergic rhinitis.Topical
      nasal steroids have demonstrated efficacy in the treatment of nonallergic rhinitis and are
      considered first-line empiric therapy.With the perceived safety of nasal steroids, their use
      for the treatment of upper respiratory allergy has become more common.However, inhaled and
      nasal steroids might be absorbed systemically. Although the systemic absorption of inhaled
      and nasal steroids has been established, the clinically relevant ocular side effects are
      poorly defined. A large prospective study in 1995 by Samiy et al reported no statistically
      significant increase of IOP in 187 patients without glaucoma taking inhaled steroids for
      various pulmonary conditions. Similarly, a large case-control study in 1997 cases suggested
      that the presence of nasal steroid use in patients with newly diagnosed glaucoma or OHT
      versus nonglaucomatous patients was not statistically significant (odds ratio, 1.02; 95% CI,
      0.59-1.77). However, the number of patients taking continuous high-dose nasal steroids was
      too small for statistical analysis. In 1998, a small prospective study of 26 non-glaucomatous
      patients revealed no evidence of OHT or cataracts after prolonged use of nasal steroids after
      endoscopic sinus surgery (mean follow-up, 8.8 ± 3.6 months; range, 3-19 months). A study of
      61 patients with seasonal allergic rhinitis taking nasal fluticasone for 1 year showed no
      increased risk for glaucoma.However, no information was described regarding their glaucoma
      risk status before steroid use in this study. Six cases of increased IOP associated with
      combined nasal and inhaled steroid use in non-glaucomatous patients have been reported.

      Considering the large number of patients on nasal steroids; It is surprising that no one has
      investigated if nasal steroid use is contraindicated in glaucoma patients.
    

Intervention name(s): Nasal steroid Beclomethasone; Saline
Intervention type(s): Drug; Drug
Intervention description(s): Beclomethasone nasal steroids to be given to a very well controlled glaucoma patients to find if this normal dose will lead to increase in intraocular pressure up to 20% where the study will be stopped at this point.; control group will receive normal saline inhaler
Other intervention name(s): Beconase
Intervention MeSH terms: Beclomethasone
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: glaucoma, steroid, nasal