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

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. Types: Ophthalmological Anti-inflammatory Agent

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

V. 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

VI. 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

VII. Mechanism: Ocular NSAID

  1. Inhibits ocular prostaglandins, and reduces inflammation

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 NSAID

  1. Pregnancy Category C
  2. Appears safe in Lactation

X. References

  1. LoVecchio (2020) Crit Dec Emerg Med 34(1): 28

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Related Studies

Ontology: Ophthalmic anti-inflammatory preparation (C0304698)

Concepts Biomedical or Dental Material (T122)
SnomedCT 33133009
Spanish preparado oftálmico antinflamatorio (producto), preparado oftálmico antinflamatorio, preparado antiinflamatorio oftálmico, preparado antiinflamatorio oftálmico (producto), preparado oftálmico antinflamatorio (sustancia)
English Ophthalmic anti-inflammatory preparation (product), Ophthalmic anti-inflammatory preparation, Ophthalmic anti-inflammatory preparation, NOS, Ophthalmic anti-inflammatory preparation (substance)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Ketorolac Ophthalmic Product (C0717876)

Concepts Clinical Drug (T200)
SnomedCT 421787008
English Ophthalmic ketorolac (product), Ophthalmic ketorolac, ketorolac ophthalmic, Ketorolac Ophthalmic Product
Spanish ketorolac para administración oftálmica (producto), ketorolaco para administración oftálmica (producto), cetorolac para administración oftálmica, ketorolac para administración oftálmica, ketorolaco para administración oftálmica
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Ophthalmic diclofenac sodium (C0719890)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
SnomedCT 386684004
English Diclofenac Sodium Ophthalmic, Ophthalmic diclofenac sodium (product), Ophthalmic diclofenac sodium
Spanish diclofenaco sódico oftálmico (producto), diclofenaco sódico oftálmico
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Voltaren Ophthalmic (C0724376)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
English Voltaren Ophthalmic, voltaren ophthalmic
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Ophthalmic anti-inflammatory agent (C1298639)

Concepts Pharmacologic Substance (T121)
SnomedCT 373758004
Spanish agente antinflamatorio oftálmico (sustancia), agente antiinflamatorio oftálmico (sustancia), agente antiinflamatorio oftálmico, agente antinflamatorio oftálmico
English Ophthalmic anti-inflammatory agent (substance), Ophthalmic anti-inflammatory agent
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: ophthalmological anti-inflammatory agents (C2013100)

Concepts Pharmacologic Substance (T121)
English ophthalmological anti-inflammatory agents, ophthalmological anti-inflammatory agents (medication), ophthalmologicals anti-inflammatory
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Acular Ophthalmic Product (C3224070)

Concepts Clinical Drug (T200)
English Acular Ophthalmic Product
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Antiinflammatory agents, non-steroidal, ophthalmologic (C3653520)

Concepts Pharmacologic Substance (T121)
English Antiinflammatory agents, non-steroidal, ophthalmologic, Antiinflammatory agents, non-steroids
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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