What are the side effects of bromfenac (nonsteroidal anti-inflammatory drug) eyedrops?

Side Effects of Bromfenac Eyedrops

Bromfenac ophthalmic solution can cause several side effects, with the most common being ocular irritation, burning sensation, and eye pain. 1

Common Side Effects

• The most frequently reported adverse reactions (occurring in 2-7% of patients) include:
  • Abnormal sensation in the eye 1
  • Conjunctival hyperemia (eye redness) 1
  • Eye irritation (including burning/stinging) 1
  • Eye pain 1
  • Eye pruritus (itching) 1
  • Headache 1
  • Iritis 1

Serious Side Effects

Bromfenac, like other topical NSAIDs, can cause serious corneal complications, particularly with prolonged use:

• Corneal erosion 1
• Corneal perforation 1
• Corneal thinning 1
• Epithelial breakdown 1

Risk Factors for Complications

Patients with the following conditions are at higher risk for serious corneal complications:

• Pre-existing corneal disease 2
• Concurrent use of multiple eye medications 3
• Frequent dosing of eye medications 3
• Dry eye disease 3

Medication-Induced Keratoconjunctivitis

Bromfenac, as a topical NSAID, can cause medication-induced keratoconjunctivitis with the following characteristics:

• Conjunctival injection 3
• Punctal edema 3
• Inferior fornix and bulbar conjunctival follicles 3
• Keratitis (especially inferonasal) 3
• Contact dermatitis of eyelids with erythema and scaling in some cases 3

Precautions and Monitoring

• Patients should be monitored for signs of corneal epithelial breakdown, especially those with pre-existing corneal conditions 1
• Prolonged use of topical NSAIDs can cause toxicity and should be tapered as inflammation improves 3
• Medication toxicity can cause worsening inflammation or even corneal melting 3
• If a persistent epithelial defect develops while the infection is under control, adjunctive therapies to rehabilitate the surface should be instituted 3

Comparison to Other Medications

• Bromfenac has been reported to have fewer ocular adverse events compared to placebo in clinical trials 4
• Unlike topical corticosteroids, bromfenac does not increase intraocular pressure or worsen/develop cataracts 3
• However, like other NSAIDs, prolonged use can lead to corneal complications 3

Special Considerations

• Patients with dry eye disease should be monitored closely as they may be at higher risk for complications 3
• Preservative-free formulations may be preferable for patients requiring frequent dosing 3
• Patients using multiple eye medications should wait 5-10 minutes between applications to prevent washout effects 5

When to Seek Medical Attention

Patients should discontinue use and contact their healthcare provider if they experience:

• Persistent eye pain 5
• Vision changes 5
• Increased redness 5
• Signs of corneal epithelial breakdown 1

Bromfenac eyedrops are generally well-tolerated when used as directed for short-term treatment of postoperative inflammation, but careful monitoring is essential, particularly in patients with pre-existing ocular surface disease 6, 7.