What is the recommended duration of treatment with ketorolac (generic name) eye drops for a patient with an eye abrasion?

Duration of Ketorolac Eye Drops for Corneal Abrasion

Ketorolac eye drops should be used for a maximum of 24-48 hours as adjunctive pain relief only, not as primary treatment for corneal abrasions, and should be discontinued once adequate pain control is achieved with oral analgesics.

Primary Treatment Approach

The cornerstone of corneal abrasion management is topical antibiotic prophylaxis, not ketorolac. 1, 2, 3

• Topical broad-spectrum antibiotic drops (fluoroquinolones preferred) should be applied 4 times daily until complete epithelial healing is confirmed, typically initiated within 24 hours of injury 1, 2, 3
• Standard prophylaxis continues until complete epithelialization, usually 3-7 days depending on abrasion size 1
• For simple abrasions in non-contact lens wearers, antibiotic drops alone are typically sufficient 2, 3

Role and Duration of Ketorolac

Ketorolac serves only as adjunctive analgesic therapy, not primary treatment:

• Ketorolac 0.5% provides short-term pain relief (24-48 hours maximum) for symptomatic management while the epithelium heals 4, 5
• Research demonstrates ketorolac significantly reduces pain, photophobia, and foreign body sensation at 24 hours compared to placebo 4
• Ketorolac does NOT accelerate healing time and should be discontinued once oral analgesics provide adequate pain control 4, 5, 6

Evidence-Based Limitations

The evidence for ketorolac in corneal abrasions has important caveats:

• A Cochrane review found low to very low certainty evidence supporting topical NSAIDs for corneal abrasion pain management 6
• The primary benefit is reduced need for oral "rescue" analgesia at 24 hours (RR 0.46,95% CI 0.34-0.61) 6
• Rare but serious complications have been reported with topical NSAIDs in case series, particularly with prolonged use 7
• No studies support use beyond 48-72 hours 4, 5, 6

Recommended Treatment Algorithm

For Simple, Non-Contact Lens Related Abrasions:

1. Initiate fluoroquinolone drops (moxifloxacin 0.5% or gatifloxacin) 4 times daily until healed 1, 2
2. Add ketorolac 0.5% every 6 hours for 24-48 hours ONLY if pain is severe 4, 5
3. Prescribe oral acetaminophen or NSAIDs as primary analgesic 2, 3
4. Discontinue ketorolac after 24-48 hours and continue oral analgesics as needed 4, 5
5. Continue antibiotic drops until complete healing confirmed by fluorescein staining 1, 2

For Contact Lens-Related Abrasions:

• Never use ketorolac as monotherapy - antipseudomonal antibiotic coverage is mandatory 1, 2
• Avoid eye patching entirely due to increased bacterial keratitis risk 1, 2, 3

Critical Pitfalls to Avoid

• Do NOT use ketorolac beyond 48-72 hours - no evidence supports prolonged use and complications increase 7, 6
• Do NOT substitute ketorolac for antibiotic prophylaxis - ketorolac has no antimicrobial properties 8, 4
• Do NOT use topical steroids initially - they delay healing and increase infection risk 1, 2
• Children require close follow-up within 24-48 hours when using topical NSAIDs due to rare serious complications 7

Warning Signs Requiring Immediate Escalation

Discontinue ketorolac and escalate care if:

• Increasing pain after initial improvement suggests infection 1, 2, 3
• Purulent discharge or corneal infiltrate indicates bacterial keratitis 1, 2
• No improvement in pain after 24-48 hours warrants ophthalmology referral 1, 7
• Central infiltrate >2mm or deep stromal involvement requires immediate cultures and fortified antibiotics 1

Bottom Line

Ketorolac is an optional adjunct for 24-48 hours maximum, not a primary treatment. The essential therapy is topical antibiotic prophylaxis continued until complete healing, typically 3-7 days. 1, 2, 3, 4, 5