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

1. See Also
   1. Ophthalmic Corticosteroid
   2. Ophthalmic Cyclosporine (Ophthalmic Calcineurin Inhibitor, Restasis)
   3. Allergic Conjunctivitis
   4. NSAID
2. 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)
3. Contraindications: Ocular NSAID
   1. Avoid combining with topical ocular Corticosteroids (unless directed by ophthalmology)
4. Types: Ophthalmological Anti-inflammatory Agent
   1. Ocular Nonsteroidal Antiinflammatory Drug (Ocular NSAID)
   2. See Ophthalmic Corticosteroid
   3. See Ophthalmic Cyclosporine (Ophthalmic Calcineurin Inhibitor, Restasis)
5. 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
6. 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
7. Mechanism: Ocular NSAID
   1. Inhibits ocular prostaglandins, and reduces inflammation
8. 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)
9. Safety: Ocular NSAID
   1. Pregnancy Category C
   2. Appears safe in Lactation
10. References
    1. LoVecchio (2020) Crit Dec Emerg Med 34(1): 28