Placebo-controlled randomised controlled trials (RCTs) that assessed the ocular efficacy of intranasal corticosteroids in patients with seasonal allergic rhinitis were eligible for inclusion in the review. Ocular efficacy could be assessed as a primary or secondary outcome or as part of a non-nasal symptom score (which included three ocular symptoms such as eye-itching, eye tearing, eye redness and ear/palate itching). Eligible intranasal corticosteroids were beclomethasone dipropionate, budesonide, ciclesonide, flunisolide, fluticasone furoate, fluticasone propionate, mometasone furoate and triamcinolone acetonide.
Ten of the included studies compared intranasal corticosteroids to placebo and also included an active comparator arm (another intranasal corticosteroids or antihistamine). Included patients included both males and females with mild to severe seasonal allergic rhinitis at baseline. Seasonal allergic rhinitis was due to various allergens (such as birch, ragweed, grass and mountain cedar pollen). Most participants were aged 12 years and over (minimum age for inclusion was six years). Study duration was at least two weeks (range one treatment to six weeks). Reported outcomes included total ocular symptom scores (TOSS), instantaneous TOSS (iTOSS), reflective TOSS (rTOSS) and non-nasal symptom scores (eye and ear related) measured using either a four-point categorical scale or 100-point or seven-point visual analogue scale. Eye-related symptoms (included itching, burning, irritation, tearing, watering, redness and puffiness) were usually assessed by physicians or patients using diary cards. Where reported, studies were typically multicentre and based in USA, Canada, Italy, UK, Denmark, France, Sweden and Norway.
The authors did not state how papers were selected for the review.