Pharm

Ocular NSAID

search

Ocular NSAID, Ocular Nonsteroidal Antiinflammatory Drug, Ophthalmologic Nonsteroidal Antiinflammatory Agent, Ketorolac Ophthalmic, Ophthalmic Acular, Diclofenac Ophthalmic, Voltaren Ophthalmic, Ophthalmic Diclofenac, Ophthalmological Anti-inflammatory Agent, Ophthalmic Anti-inflammatory Preparation, Ophthalmic Anti-inflammatory Agent

  • See Also
  1. Ophthalmic Corticosteroid
  2. Ophthalmic Cyclosporine (Ophthalmic Calcineurin Inhibitor, Restasis)
  3. Allergic Conjunctivitis
  4. NSAID
  • Indications
  • Ocular NSAID
  1. Allergic Conjunctivitis
  2. Episcleritis
  3. Corneal Abrasion (off-label use)
    1. Several articles have supported use
      1. Scucs (2000) Ann Emerg Med 35(2):131-7 [PubMed]
      2. Smith (2012) Can Fam Physician 58(7): 748-9 [PubMed]
    2. However 2017 Cochrane review noted insufficient evidence to recommend
      1. Wakai (2017) Cochrane Database Syst Rev 5:CD009781 +PMID: 28516471 [PubMed]
  4. Postophthalmic surgery patients
    1. Postoperative ophthalmic pain
    2. Prevention of crystaloid Macular edema after Cataract surgery (used for 2 weeks after surgery, starting at 24 hours)
  • Contraindications
  • Ocular NSAID
  1. Avoid combining with topical ocular Corticosteroids (unless directed by ophthalmology)
  • Mechanism
  • Ocular NSAID
  1. Inhibits ocular Prostaglandins, and reduces inflammation
  • Types
  • Ophthalmological Anti-inflammatory Agent
  1. Ocular Nonsteroidal Antiinflammatory Drug (Ocular NSAID)
  2. See Ophthalmic Corticosteroid
  3. See Ophthalmic Cyclosporine (Ophthalmic Calcineurin Inhibitor, Restasis)
  1. Ketorolac 0.5% (Acular) 1 drop every 6 hours for no more than 7 days
  2. Diclofenac 0.1% (Voltaren) 1 drop every 6 hours for no more than 14 days
  • Preparations
  • Ocular NSAID Use in Postophthalmic Surgery
  1. Flurbiprofen Sodium 0.03% (Ocufen) used in perioperative period by ophthalmology
  2. Bromfenac 0.09% (Xibrom) 1 drop twice daily (avoid in Sulfa Allergy)
  3. Nepafenac 0.1% (Nefanac) 1 drop three times daily
  4. Diclofenac 0.1% (Voltaren) 1 drop every 6 hours for no more than 14 days after Cataract surgery (starting 24 hours post-op)
  • Adverse Effects
  • Ocular NSAID
  1. Initial burning or stinging on application
  2. Delayed Corneal Wound Healing
  3. Keratitis
  4. Corneal edema
  5. Corneal deposits
  6. Corneal thinning (or Corneal perforation)
  1. Pregnancy Category C
  2. Appears safe in Lactation
  • References
  1. LoVecchio (2020) Crit Dec Emerg Med 34(1): 28
  2. LoVecchio (2024) Crit Dec Emerg Med 38(5): 34