title: Over-the-counter migration of steroid use: impact on the eye.
abstract: OBJECTIVE
  To provide opinions on the potential impact of increasing use of steroids by various formulations, as recent approvals have switched intranasal steroids to over-the-counter (OTC) status. Systemic glucocorticosteroids are the predominant formulations available only by prescription, whereas low-dose dermatological formulations are also available OTC. The recently approved OTC intranasal steroid has generated questions on their potential adverse effects, especially on the eye.
  
  
  RESULTS
  Oral and ophthalmic steroids have the most potent impact on the development of increased intraocular pressure (IOP) and lens opacifications (ILO), but other factors such as age, race and comorbidities (e.g. hypertension, diabetes and smoking) also play a role. There are no biomarkers that have been established to identify populations at additional risk. However, individuals of Caribbean, African, Hispanic or Asian ancestry have a higher predilection for the development of glaucoma and thus may be predisposed to IOP. ILO has been noted to have a slight increase with intranasal corticosteroids, but no specific correlations with the development of cataracts.
  
  
  CONCLUSIONS
  The OTC placement of intranasal steroid may cause a subset of genetically sensitive individuals to earlier development of IOP and ILO, but the socioeconomic benefit for patients with allergies having access to the 'OTC open formulary' appears to warrant consideration with caveats of monitoring the effect at large, especially in susceptible populations such as those with a family history or specific ancestries.
authors.affiliation: aDepartment of Ophthalmology, New York Medical College, Valhalla, New York bDepartment of Medicine, Robert Wood Johnson University Hospital, Rutgers University, New Brunswick, New Jersey, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Bielory
authors.forename: Leonard
authors.initials: L
authors.lastname: Bielory
mesh_terms: D000281:Administration, Intranasal; D002386:Cataract / Q000139:chemically induced / Q000453:epidemiology*; D005006:Ethnicity; D005123:Eye / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D004366:Nonprescription Drugs / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D009798:Ocular Hypertension / Q000139:chemically induced / Q000453:epidemiology*; D012306:Risk
chemical_list: D005938:Glucocorticoids; D004366:Nonprescription Drugs