Ocular Side Effects of Flonase

1:17 PM

Runny nose, itching, sneezing?  In the past, you might have just reached for OTC anti-histamines like Claritin.  But when you bring these complaints to your primary care doctor, sometimes you and your doctor will opt for a prescription strength treatment.  Over the past few years, Flonase (fluticasone) has become an overwhelmingly popular choice as a prescription medication for chronic seasonal (and perennial!) allergy sufferers.  Flonase is a steroid nasal spray, meaning that its key method of action is to fight the inflammation causing all of those allergy symptoms.  Many people are aware of the long term side effects of prolonged steroid use, and there are some potential ocular effects that your doctor should discuss with you:

Via

1) Risk of Increased Eye Pressure
Everytime you visit your eye doctor, they measure the pressure inside the eye (commonly with a "puff of air" from an instrument called a NCT).  This measurement helps detect risk for glaucoma, which is a potentially blinding disease of the eye that is often associated with elevated ocular pressure.  Normal eye pressure is considered to be 21 mmHg or lower.  Steroid use has been known to raise ocular pressure in a percentage of the population. Studies suggest that about 5% of the population can have a significant pressure spike with steroid use.  The good news?  Once you stop the steroids, your pressure will normalize.  For this reason, if you have been diagnosed with glaucoma or know you have a history of elevated intraocular pressure, Flonase or any other steroids should be used with caution, and your pressure should be monitored closely.  

2) Risk of Cataract Formation
A cataract is a "cloud" that develops inside the eye as a structure called the lens hardens with time.  All of us will get a cataract eventually.  But steroids are known to increase the cataract formation process, causing cataracts in younger people.  Steroids are also associated with a faster growing, more visually disruptive type of cataract called posterior subcapsular.  With long-term steroid use, the risk for this type of cataract development greatly increases.
Herpes Simplex looks similar to other more common
eye infections; it takes a trained ocular specialist to
determine the difference.  Photo via 

3) Risk of Viral Infection in the Eye
Have you ever had a herpes infection of the eye?  This type of virus can cause lesions on the skin, eyelid, and eye itself, and can be very difficult to treat.  In some cases, the eye is so damaged by the infection that permanent scarring and severe vision loss may occur.  If you have ever had a herpes infection of the eye or face, steroid use is contraindicated!

If you are taking Flonase, make sure you are also getting a yearly eye examination to help detect any issues and avoid developing these potentially severe side effects!

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21 comments

  1. Is there a link between nuclear sclerotic cataracts and the use of flonase?

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  2. Current literature links steroid-induced cataracts more specifically with the Posterior Subcapsular variety, but we currently don't even understand the exact process of how a cataract develops, so it could increase the rate of nuclear sclerotic changes as well. Why do some people have nuclear sclerotic and some cortical? We just don't know exactly. Traditional thought states nuclear sclerotic is primarily your "normal" aging and UV exposure cataract.

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  3. Inside of eye peeling.. Anyone else!

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    1. Definitely see your eye doctor ASAP! You could be having a significant allergic reaction to this medication, or it could be an unrelated allergic, inflammatory, or infectious condition.

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  4. I had retinal detachment two years ago, and have had four re-attachment surgeries since. Before the last one, I had developed a cataract so badly, that I had to have cataract surgery prior to it. I developed a terrible allergy about eight months ago, finally found Flonase, and used it daily as prescribed, for about three months. By the end of that period, my vision in the same eye had degenerated terribly (I still have silicone oil in it, but the sharpness of the vision faded by the end of my usage of Flonase). Now I feel like the inside of my new lens seems to be coated with the Flonase, so I see very little, so much so that the doctor said he was willing to remove the oil, but he thinks I still will not see anything better. I think the decrease of vision that occurred was due to the Flonase. Have you heard of anything like this? Recommend? Thanks.

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    1. I haven't personally heard of or been able to find reported cases in the literature of Flonase causing issues with build up on the IOL implant after cataract surgery. There are quite a few case studies involving vision loss due to build up in the IOL in patients with silicone oil however. In some cases the buildup on the IOL isn't even visible to the doctor. It may be worth getting the opinion of a local cataract surgeon/anterior segment specialist to see if your IOL might be damaged or distorted and need to be exchanged to a material that wouldn't interact negatively with the silicone oil. You can find a few case study reports here: http://www.nature.com/eye/journal/v16/n3/full/6700066a.html. Hope this helps!

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    2. Thank you very much.

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  5. Curious... I have had both of my corneas transplanted within the last 18 months and am currently using Lotemax as an anti-rejection solution. With one of its side effects being an elevation in eye pressure, is it safe to assume that I should steer away from products like Flonase that may further elevate the pressure?

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    1. Not necessarily but it would be a good idea to ask your doctor. If you are on Lotemax long term they will be monitoring your intraocular pressure closely. If your doctor thinks your eye pressure is of no concern, they may not see a problem with using Flonase concurrently.

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    2. Thanks Dr. L, your feedback is greatly appreciated!

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  6. I was recently diagnosed with a retina tear and was treated with lazar treatment. In May 2016 I was prescribed Flonase (generic) by my pcp. I used this daily as prescribed for several months; May to September, prior to being diagnosed with retina tear. The onset was sudden. I wondered about the Flonase (I take no other rx, and use only zyrtec as medication) and started t read correlation between retina tear/detachment complaints and use of Flonase. The complaints are similar to my own. I am wondering if there may be more people experiencing this and haven't made the connection. Your thoughts? I am still seeing my retina specialist and will bring this up with him.

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    1. I haven't found any studies published linking the two at this time.

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    2. I ended up with glaucoma and had to have my cataracts replaced

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  7. I was given Flonase three months ago during a cold virus. I only used it for one week. I am 50 and have always had good eyesight (other than near sided). 20/20 with prescription lenses.

    About two months ago I started getting blurred vision in my left eye. A month ago I went to the eye doctor as it was getting worse. They told me I had a posterior subcapsular cateract brought on by steroid use. At that point I didn't remember taking any steroids, but later figured out which I had taken. The doctor recommended removal of the cataracts and gave me a referral. The soonest I could get an appointment at the specialist is December 19th for consult.

    At that first doctors appointment my vision was very annoying in that eye, but I could still function and drive. About a week ago upon waking I noticed it has gotten much more severe. I can not see any detail whatsoever with my left eye. I only see shadows and light. I no longer drive because I can't judge distance at all. And can't see to the left.

    How can it get so severe so rapidly? Should I be concerned? Any info you can provide is greatly appreciated!

    Diana

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    1. There are so many causes of cataracts, from age, to diet, genetics, sun exposure, and overall systemic health that it's hard to answer what specifically has made you develop one so quickly. Your doctor will be familiar with your personal health history and can give you better suggestions as to your personal risk factors. The great thing is that cataracts are completely treatable, and once they are removed they can never come back.

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  8. Have you found any cases of temporary blindness caused by Flonase? My 13-year-old daughter was prescribed Flonase in December as part of treatment for a sinus infection. She took it daily for about a week. She became sick again with another upper respiratory infection recently and she used Flonase one evening. The next afternoon she lost vision in both eyes, thankfully, only for about 4 hours. An MRI, bloodwork found no apparent reasons for the loss of vision. She has no other health issues and experienced no trauma that might have damaged her eyes. The ER doctors recommended she see an ophthalmologist but in the meantime we are worried that this will occur again. The Flonase is the only thing we can identify that was out of the norm. Thank you!

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    1. I'm not familiar with any case studies linking the two. Definitely worth seeing the specialist for more investigation. Migraines can cause similar experiences as you described too (can be ocular only without a headache).

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    2. My vision became blurred and was diagnosed with glaucoma and fad to have my cataracts replaced which is not cheap.

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  9. Hello, I have been using mometasone spray for my nose for about 2 months , and today for my annual eyes routine check , my doctor told me for the first time that i had quiet high pressure for my age (22 year old and 21 mmhg of pressure) , should i see a link with my use of mometasone and should i be worried ? by the way thank you very much for your article, I'm from France and this was really useful as I didn't found any complete article as yours :)

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    1. A pressure of 21 mmHg isn't necessarily alarming if you always have pressures in the high teens or around 20, but if you are usually around 10-15 and it jumped up that high it could be a side effect of the steroid use. Definitely talk to your doctor about the medication you are taking and if they feel there is a link.

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