Intranasal steroid injections and blindness: Our personal experience and a review of the past 60 years

• Published in: The Laryngoscope 2015-04, Vol.125 (4), p.796-800
• Main Authors: Moss, William J., Kjos, Kari B., Karnezis, Tom T., Lebovits, Marc J.
• Format: Article
• Language: English
• Subjects: Administration, Intranasal; Adult; Aged; Aged, 80 and over; blindness; Blindness - chemically induced; Blindness - epidemiology; Chronic Disease; Cohort Studies; Female; Follow-Up Studies; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Humans; Incidence; injection; Injections, Intralesional; Intranasal; Male; Medical research; Middle Aged; Patient Safety; Retrospective Studies; Rhinitis - diagnosis; Rhinitis - drug therapy; Risk Assessment; Sinusitis - diagnosis; Sinusitis - drug therapy; steroid; Time Factors; Treatment Outcome; Triamcinolone Acetonide - administration & dosage; Triamcinolone Acetonide - adverse effects; Young Adult
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.25000

Objectives/Hypothesis To assess for the safety of intranasal steroid injections. Study Design Retrospective chart review and review of the medical literature. Methods Seventy‐eight patients with chronic rhinitis or sinusitis underwent 237 intraturbinate or intrapolyp triamcinolone acetonide injections between April 2008 and June 2013 at a single, private, outpatient otolaryngology clinic. A retrospective chart review was performed to evaluate for treatment complications, symptom improvement, and demographic data. A PubMed literature search was performed for all case series extracting the incidence of visual complications following intranasal steroid injections. All published reports of visual complications from these series and independent case reports were compiled and analyzed. Results Of the 237 injections performed, 152 were intraturbinate and 85 were intrapolyp. One of the intrapolyp injections resulted in a transient visual change that resolved spontaneously. Nine other case series meeting the search criteria were found. Of the reported 117,669 injections performed, three resulted in visual complications yielding an estimated visual complication rate of 0.003%. All three of these events resolved spontaneously and resulted in no permanent visual deficits. A total of 19 reports of visual complications following intranasal steroid injections were discovered. Of these, the majority have insufficient detail regarding the injection technique or cite gross deviation from the correct injection protocol. Conclusion Intranasal steroid injections are a safe treatment for chronic rhinitis and sinusitis patients. When performed correctly, there is evidence to justify the use of methylprednisolone acetate or triamcinolone acetonide injections into the inferior turbinates and nasal polyps. Level of Evidence 4. Laryngoscope, 125:796–800, 2015