Is ketorolac (nonsteroidal anti-inflammatory drug) eye solution plus ofloxacin (fluoroquinolone antibiotic) eye drops effective for treating conjunctivitis?

Ketorolac Plus Ofloxacin for Conjunctivitis: Not Recommended

This combination is not appropriate for treating conjunctivitis because ketorolac is indicated only for allergic conjunctivitis (not bacterial), while ofloxacin treats bacterial conjunctivitis (not allergic)—these are fundamentally different disease processes requiring different therapeutic approaches. 1, 2, 3

Understanding the Mismatch

Ketorolac's Role

• Ketorolac tromethamine 0.5% is a topical NSAID that inhibits prostaglandin biosynthesis and is FDA-approved specifically for temporary relief of ocular itching caused by seasonal allergic conjunctivitis 3
• It reduces prostaglandin E2 levels in aqueous humor, addressing the inflammatory mediators of allergic (not infectious) disease 3
• Clinical trials demonstrate efficacy in reducing itching and conjunctival inflammation in allergic conjunctivitis, with dosing of one drop four times daily 3, 4, 5

Ofloxacin's Role

• Ofloxacin 0.3% is a fluoroquinolone antibiotic effective against common bacterial pathogens including Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae 2, 6, 7
• It is recommended for bacterial conjunctivitis, typically dosed four times daily for 5-7 days 2, 6, 8
• The WHO and American Academy of Ophthalmology endorse topical ofloxacin as an appropriate choice for bacterial conjunctivitis 1, 2

The Correct Approach by Etiology

For Bacterial Conjunctivitis

• Use ofloxacin alone (or another fluoroquinolone like moxifloxacin or levofloxacin) for 5-7 days 2, 9
• Topical antibiotics provide earlier clinical and microbiological remission compared to placebo 2
• Adding ketorolac provides no benefit and exposes patients to unnecessary medication 1

For Allergic Conjunctivitis

• Use ketorolac alone (or preferably second-generation antihistamines with mast-cell stabilizing properties like olopatadine) 1, 2
• Ketorolac is effective for itching relief but has slower onset than dual-action agents 1, 4
• Adding ofloxacin provides no benefit for allergic disease and contributes to antibiotic resistance 2

For Viral Conjunctivitis

• Neither medication is appropriate—supportive care with artificial tears and cold compresses is recommended 2
• Avoid antibiotics due to potential adverse effects and lack of efficacy 2

Critical Clinical Pitfalls

The fundamental error is treating conjunctivitis without first determining the etiology. 2 Key distinguishing features include:

• Bacterial: Mucopurulent discharge, yellow crusting, morning matting 2, 9
• Allergic: Bilateral itching, watery discharge, history of atopy 1, 2
• Viral: Watery discharge, preauricular lymphadenopathy, recent upper respiratory infection 2

Indiscriminate use of topical antibiotics or anti-inflammatories should be avoided, as this can induce toxicity, prolong infections, and promote antibiotic resistance 2

When Combination Therapy Is Appropriate

The only scenario where ketorolac might be combined with antibiotics is postoperative cataract surgery, where ketorolac reduces inflammation while prophylactic antibiotics prevent infection—but this is not conjunctivitis treatment 3