NSAID Eye Drops
Several nonsteroidal anti-inflammatory drugs (NSAIDs) are available as ophthalmic solutions, with ketorolac and diclofenac being the most commonly used formulations. 1, 2
Available NSAID Eye Drop Formulations
Ketorolac Tromethamine
- Available concentrations: 0.5% and 0.4% ophthalmic solutions 1, 3
- FDA-approved indications: Reduction of ocular pain and burning/stinging following corneal refractive surgery, and temporary relief of ocular itching caused by seasonal allergic conjunctivitis 4, 1
- Formulation details: Supplied as a sterile isotonic aqueous solution with pH 7.4, containing benzalkonium chloride 0.01% as preservative 1
Diclofenac Sodium
- Available concentration: 0.1% ophthalmic solution 2
- Clinical applications: Post-surgical inflammation following cataract surgery, seasonal allergic conjunctivitis 5
Nepafenac
- Available concentration: 0.1% ophthalmic solution 6
- Clinical use: Has been studied for treating acute central serous chorioretinopathy, applied three times daily for 4 weeks or until complete subretinal fluid resolution 6
Clinical Applications by Condition
Allergic Conjunctivitis
- Ketorolac is indicated for temporary relief of ocular itching caused by seasonal allergic conjunctivitis 4
- Classified as a second-line treatment option after dual-action agents (antihistamine + mast cell stabilizer combinations) 4
- Both ketorolac and diclofenac demonstrate comparable efficacy in reducing ocular signs and symptoms of acute seasonal allergic conjunctivitis 5
Post-Surgical Use
- Topical NSAIDs are recommended for use within the first post-surgical month following cataract surgery as part of preservative-free eye-drop regimens 6
- Ketorolac 0.4% is as effective as ketorolac 0.5% for controlling inflammation after cataract surgery, including prevention of cystoid macular edema 3
Corneal Abrasions
- Ketorolac 0.5% provides significantly decreased pain, photophobia, and foreign body sensation when used as adjunctive therapy for traumatic corneal abrasions 7
- Allows shorter time to resumption of normal activities without increasing complication rates 7
Critical Safety Warnings
Corneal Complications
- All topical NSAIDs may result in keratitis, corneal thinning, corneal erosion, corneal ulceration, and corneal perforation with continued use 2
- Adverse events including corneal-scleral melts, perforation, ulceration, and severe keratopathy can occur with continued NSAID use 6
- Patients with corneal epithelial breakdown should immediately discontinue topical NSAIDs 2
High-Risk Populations
- Increased risk for sight-threatening corneal adverse events in patients with: complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface disease (dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period 2
- Use more than 24 hours prior to surgery or beyond 14 days post-surgery increases risk for occurrence and severity of corneal adverse events 2
Duration Limitations
- Maximum recommended duration is 2-4 weeks for topical NSAIDs in ocular dryness management to avoid serious adverse events 6
- Short-term therapeutic approach only, as prolonged use carries significant risks 6
Contraindications and Precautions
- Should not be prescribed for patients with aspirin or NSAID allergy or the combination of asthma and nasal polyps unless the patient is known to tolerate aspirin 8
- Use with caution in patients with known bleeding tendencies or receiving medications that prolong bleeding time 2
- Should not be used by patients wearing soft contact lenses (except bandage hydrogel lenses during first 3 days following refractive surgery) 2