Nasal steroids don't have an adverse effect on eyes

Medical Matters

August 04, 2006|By JUDY FOREMAN

Do nasal steroids taken for allergies cause eye problems?

Steroids, especially those inhaled through the mouth to control asthma and those taken orally or intravenously for conditions such as arthritis and emphysema, can cause side effects in the eye, including cataracts and glaucoma.

But steroids such as Flonase, which are sniffed just through the nose, appear to be fairly safe for the eye.

In fact, the most common side effects of nasal steroids are a burning sensation in the nose or bleeding, especially if steroids are sprayed directly on the septum, the cartilage-based tissue that divides the two nostrils, said Dr. Ralph Metson, a sinus surgeon at the Massachusetts Eye and Ear Infirmary. To avoid these problems, he said, spray toward the outside of the nostrils, not toward the septum.

Although oral steroids can increase the risk for cataracts (a clouding of the lens in the eye), nasal steroids do not, according to a major British study. The researchers, who looked at more than 88,000 patients who used nasal steroids, more than 98,000 taking oral steroids and another 98,000-plus who were not taking steroids, reported their findings in the Journal of Allergy and Clinical Immunology in 2000.

As for glaucoma, a build-up of pressure inside the eye, a small study of 12 patients published in the same journal last year by researchers from the Vanderbilt Eye Institute found that those who already have glaucoma may see their condition worsen with nasal steroids. This condition improves when nasal steroids are discontinued, the authors said.

Dr. Harry Quigley, director of the glaucoma service at the Wilmer Eye Institute at the Johns Hopkins Medical Institutions, said this and other studies suggest that doctors who prescribe nasal steroids for allergy or sinus patients should ask whether they, or close family members, have glaucoma.

I just had a kidney stone. How can I avoid getting another one?

In many cases they can be avoided by drinking lots of fluids and changing the diet.

Kidney stones occur when the urine contains too high a concentration of certain substances, usually calcium oxalate or calcium phosphate.

These substances clump up, forming stones. If they're smaller than a pea, the stones can be passed in the urine, albeit painfully. Larger stones may need to be removed with minimally invasive surgery or a procedure called lithotripsy, which breaks up the stones by shock waves, said Dr. Michael Choi, a kidney specialist at the Johns Hopkins School of Medicine.

Kidney stones caused nearly 3 million visits to doctors - and 600,000 trips to the emergency room - in 2000 alone, the last year for which figures are available, according to the National Institute of Diabetes & Digestive & Kidney Diseases (www.niddk.

Not drinking enough fluid is a major cause, but genetics play a role, too. (Check out the Mayo Clinic Web site,

While doctors once believed that consuming too much calcium led to kidney stones, they now believe that foods high in calcium may actually help prevent the condition.

If you've had a prior kidney stone containing calcium oxalate, though, it may be wise to limit your consumption of foods that contain the substance, including chocolate, coffee, cola, nuts, rhubarb, spinach, strawberries, tea and wheat bran.

For calcium kidney stones, it may also help to increase intake of lemon juice - the real kind, not just lemon flavoring. "This keeps calcium from binding in the kidney," said Dr. Richard Babayan, chief of urology at Boston Medical Center.

If you have uric acid stones, you should increase the alkalinity of the urine. A prescription drug called Urocit-K can do this, helping dissolve these stones. So do over-the-counter preparations of potassium citrate or sodium bicarbonate.

But the best way to prevent the condition is to drink enough liquids. That "is key for virtually everybody with kidney stones," Babayan said.

Once you do pass a kidney stone, be sure to retrieve it - some people use tea strainers. That way your doctor can determine what type of stone it is and offer recommendations that can help you avoid getting that kind again.

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