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:
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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.
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| 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!
