References
1. Mabry RL. Visual loss after intranasal corticosteroid injection. Incidence, causes, and prevention. Arch Otolaryngol. 1981;107(8):484-6.
2. Moss WJ, Kjos KB, Karnezis TT, Lebovits MJ. Intranasal steroid injections and blindness: our personal experience and a review of the past 60 years. Laryngoscope. 2015;125(4):796-800.
3. Beleznay K, Carruthers JDA, Humphrey S, Carruthers A, Jones D. Update on Avoiding and Treating Blindness From Fillers: A Recent Review of the World Literature. Aesthet Surg J. 2019;39(6):662-674.
4. Feeley IH, Healy EF, Noel J, Kiely PJ, Murphy TM. Particulate and non-particulate steroids in spinal epidurals: a systematic review and meta-analysis. Eur Spine J. 2017 Feb;26(2):336-344.
5. Massa H, Georgoudis P, Panos GD. Dexamethasone intravitreal implant (OZURDEX®) for macular edema secondary to noninfectious uveitis: a review of the literature. Ther Deliv. 2019;10(6):343-351.
6. Valenzuela CV, Liu JC, Vila PM, Simon L, Doering M, Lieu JEC. Intranasal Corticosteroids Do Not Lead to Ocular Changes: A Systematic Review and Meta-analysis. Laryngoscope. 2019;129(1):6-12.
7. Zhang EZ, Tan S, Loh I. Botolinum toxin in rhinitis: Literature review and posterior nasal injection in allergic rhinitis. Laryngoscope. 2017;127(11):2447-2454.
Figure I: Intranasal injection (Reproduced with permission)
Key Points :
1) Intranasal steroid injections were historically very effective, but fell out of favor due to devastating visual complications
2) Other specialties, such as orthopedists and neurosurgeons, had analogous, severe complications with particulate steroids
3) Thromboembolic complications can be avoided by using non-particulate steroids such as dexamethasone
4) To date, there has yet to be any significant attempt to evaluate the safety and effectiveness of intranasal dexamethasone treatments
5) The otolaryngologists’ aversion to intranasal injection treatments may not be evidence-based