Does Ibuprofen Cause Increased Eye Pressure?
No, ibuprofen does not cause increased intraocular pressure (IOP) and may actually be beneficial in reducing IOP in specific post-surgical glaucoma contexts.
Evidence Supporting Safety of NSAIDs and IOP
The available evidence demonstrates that nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen do not elevate intraocular pressure:
Flurbiprofen, an NSAID in the same class as ibuprofen, was specifically tested in double-masked fashion and did not alter IOP in known high corticosteroid responders, nor did it block corticosteroid-induced ocular hypertension 1. This is critical because it demonstrates that NSAIDs fundamentally differ from corticosteroids in their effect on IOP.
In contrast to NSAIDs, corticosteroids (both topical and systemic) are well-documented to cause IOP elevation 2. The glaucoma guidelines specifically warn about corticosteroid-induced IOP elevation as a significant clinical concern 2.
Potential Beneficial Effects of Ibuprofen on IOP
Recent evidence suggests ibuprofen may actually help lower IOP in specific clinical scenarios:
In high-risk glaucoma patients after trabeculectomy surgery, oral ibuprofen administered for ≥3 months postoperatively was associated with significantly greater IOP reductions at week 1 (mean difference: -2.89 mm Hg) and month 1 (-2.29 mm Hg) compared to patients not receiving ibuprofen 3.
Patients receiving ibuprofen after trabeculectomy had substantially lower odds of bleb failure at both the >18 mm Hg threshold (odds ratio: 0.39) and >15 mm Hg threshold (odds ratio: 0.52) 3.
No differences in adverse ocular hypotony events were observed with ibuprofen use 3.
Clinical Context: Drugs That DO Increase IOP
To provide proper context, the following medications are documented to increase IOP and should be avoided in glaucoma patients:
Sympathomimetic agents like ephedrine are contraindicated in patients at risk of increased IOP, as they can precipitate acute angle-closure glaucoma through mydriasis 4.
Anticholinergics like atropine should be avoided in patients with increased IOP or glaucoma due to risk of pupillary dilation and potential angle closure 5.
Topical and systemic corticosteroids consistently cause IOP elevation 2.
Clinical Recommendation
Ibuprofen can be safely used in patients with glaucoma or elevated IOP concerns, as it does not cause IOP elevation 1. In fact, for patients undergoing trabeculectomy who are at high risk of scarring, early adjunctive oral ibuprofen may improve surgical outcomes by reducing IOP and decreasing bleb failure rates 3. This makes NSAIDs like ibuprofen a preferred anti-inflammatory option over corticosteroids when IOP is a clinical concern.