High IOP and use of nasal fluticasone

I'm a 48 year old, white male, -5.5 in both eyes and worn soft contacts for 30 years.  Live in the Toledo,OH area.  I have no family history of high IOP.  I have regular eye exams with normal IOP until about 4 months ago.  Suddenly my IOP is in the mid 30's.  However I was using nasal spray (fluticasone) for almost 1 year prior to the high readings.  My eye doctor has done all the exams to check for vision loss and suggested there is little if any.  He recognized there may be a connection between the nasal spray and elevated IOP.  But not enough data exists to determine if this is the problem and if it will eventually go away.  But as a precaution he decided to prescribe pressure reducing drops.  I had a reaction to the drops the first day and returned to his office to report the reaction (bloodshot eyes).  While rechecking my pressures,he found that they had dropped to 16 with only one application which he suggested is not usual.  He suggested I continue on the drops for a week and then take a break and then take readings and see what happens.  I did as asked and found that my pressures were about 19.  Stayed off the drops and returned a month later for a check up and found them to be 37.  Now I'm back on drops. Is it possible the nasal spray caused this (impossible to get good data) and is it possible it will take some time for it to return to normal?  Is this very unlikely?  Should I be treating with drops for a while (and the side effects) or is a better altrenative to do a careful wait and see approach?

[Michael J Kutryb, MD]

Any effect from the steroid nasal spray would usually be gone within a few weeks.  It sounds like you are a very good SLT candidate but your pressure is so high that it might not get you low enough and you might still need one drop.  I would consider SLT and see how low it gets you in one eye.  Might not lower it enough.  If not taking a prostaglandin either xalatan or travatan z would be the most effective treatment - just learn to deal with some redness and long eyelashes.

MJK MD

[mmango]

I forgot to add that I discontinued using the nasal spray right after the first exam showed high IOP and have not used any since (about 4 months ago).  Also the first drops that brought my eye pressure down in one day by 20 points was a prostaglandin.  

During my last visit the doctor tried Combigan and in 15 minutes my pressure dropped to the low twenties.  I am now on Combigan twice a day and noticed it actually makes me tired and a litle short of breath.  Is there a once a day drop that won't have the side effects?  Would I likely be a good candidate for SLT surgery?  Is it usually successful?