Ocular NSAID

Aka: 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

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II. 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)

III. Contraindications: Ocular NSAID

  1. Avoid combining with topical ocular Corticosteroids (unless directed by ophthalmology)

IV. Mechanism: Ocular NSAID

  1. Inhibits ocular Prostaglandins, and reduces inflammation

V. Types: Ophthalmological Anti-inflammatory Agent

  1. Ocular Nonsteroidal Antiinflammatory Drug (Ocular NSAID)
  2. See Ophthalmic Corticosteroid
  3. See Ophthalmic Cyclosporine (Ophthalmic Calcineurin Inhibitor, Restasis)

VI. Preparations: General Ocular NSAID Use (includes Allergic Conjunctivitis, Corneal Abrasion)

  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

VII. 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)

VIII. 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)

IX. Safety: Ocular Diclofenac

  1. Pregnancy Category C
  2. Appears safe in Lactation

X. References

  1. LoVecchio (2020) Crit Dec Emerg Med 34(1): 28
  2. LoVecchio (2024) Crit Dec Emerg Med 38(5): 34

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