Can a patient use Floanse (flurbiprofen) a week before cataract surgery?

Using Flurbiprofen (Ocuflur) Before Cataract Surgery

Patients should discontinue topical flurbiprofen eye drops at least one week before cataract surgery to minimize bleeding risk during the procedure. 1

Mechanism and Timing Considerations

Flurbiprofen is a topical NSAID that inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis. While it's used therapeutically to maintain pupillary dilation during cataract surgery, its preoperative use follows a specific protocol:

• According to the FDA label, flurbiprofen should be administered as 4 drops beginning 2 hours before surgery (1 drop approximately every 30 minutes) 1
• It is not intended for continuous use in the days or weeks leading up to surgery

Bleeding Risk Considerations

The primary concern with using flurbiprofen a week before surgery is its effect on bleeding tendencies:

• The FDA label specifically warns that flurbiprofen "should be used with caution in surgical patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time" 1
• NSAIDs like flurbiprofen can interfere with platelet function and potentially increase surgical bleeding risk

Surgical Outcomes and Healing

Additional concerns with continued preoperative use include:

• Topical NSAIDs may slow or delay healing 1
• Concomitant use with topical steroids (commonly used perioperatively) may further increase healing problems 1

Management Algorithm

1. For patients already using flurbiprofen eye drops:

   • Discontinue at least one week before scheduled cataract surgery
   • This allows time for restoration of normal platelet function and minimizes bleeding risk

2. For patients requiring flurbiprofen for cataract surgery:

   • Follow the FDA-approved dosing: 4 drops total, administered as 1 drop every 30 minutes beginning 2 hours before surgery 1

3. For patients with dry eye disease:

   • Consider that NSAIDs like flurbiprofen can potentially exacerbate dry eye symptoms 2
   • Optimize the ocular surface before surgery with preservative-free artificial tears

Special Considerations

• Unlike intranasal corticosteroids (e.g., Nasacort) which don't need to be stopped before cataract surgery 3, topical ophthalmic NSAIDs require careful perioperative management
• If the patient is on systemic anticoagulants or antiplatelets, the American College of Chest Physicians recommends continuing these medications during minor ophthalmologic procedures 2, but this makes proper management of topical NSAIDs even more important

Pharmacokinetic Rationale

Research shows that flurbiprofen reaches its highest concentration in aqueous humor approximately 2 hours after instillation (60 ng/ml) and remains detectable for up to 7.25 hours 4. This pharmacokinetic profile supports the FDA-recommended administration schedule and explains why continuous use leading up to surgery is not indicated.