Twenty-four eyes of 12 patients taking nasal steroids were identified. The mean IOP for each pair of eyes was +/- mm Hg (range, 9- mm Hg) for the presteroid use examination, +/- mm Hg (range, 12- mm Hg) for the steroid use examination, +/- mm Hg (range, -20 mm Hg) for poststeroid use examination 1, and +/- mm Hg (range, 95- mm Hg) for poststeroid use examination 2. Eleven patients experienced decreased averaged IOP at poststeroid use examination 1 after steroid discontinuation at a mean of 35 +/- 14 days and continued to maintain this decrease on the poststeroid use examination 2 visit at a mean of 191 +/- 150 days. A significant increase between presteroid and steroid use examination IOPs (P = .007) and a significant decrease between steroid use and both poststeroid use 1 (P < .001) and poststeroid use 2 (P = .011) examination IOPs were observed. No significant difference between presteroid use and either poststeroid use examination IOPs (P = ) was found. Many patients met their target pressures and were able to avoid or delay additional glaucoma therapy.
In patients where the nasal polyps do not seem to respond to the above protocol (or if patient is refusing surgery), the addition of a very strong drug called Zyflo (zileuton) may be of benefit. This drug can cause liver damage (in <10% of patients) and as such, liver function bloodwork (AST/ALT) is required every month for 3 months and yearly thereafter. As long as the AST/ALT numbers do not exceed 150 (yes, it is higher than what is considered normal), it is generally considered safe to continue with this drug (though would check bloodwork weekly if that happens to ensure stability). Getting an immunologist involved in the care of such patients would also be beneficial, especially for those patients where the nasal polyps are particularly resistant to standard treatment.