Ophthalmic Nonsteroidal Anti-inflammatories
Key Points
- Topical ocular NSAIDs reduce postoperative eye inflammation, pain, and photophobia.
- Core agents are diclofenac and ketorolac ophthalmic solutions.
- Major safety risks include delayed healing, ocular bleeding, and corneal epithelial injury with prolonged use.
- Concurrent use with ophthalmic corticosteroids can further delay healing.
- Ocular NSAIDs may reduce the therapeutic effect of latanoprost.
Class Overview
Ocular NSAIDs inhibit cyclooxygenase and reduce prostaglandin synthesis at the ocular surface. They are used mainly after cataract extraction and corneal refractive procedures, and in selected allergic-pruritus pathways (ketorolac).
Common Agents and Typical Dosing
| Drug | Typical Adult Ophthalmic Dosing | Common Indications |
|---|---|---|
| Diclofenac 0.1% | 1 drop QID starting 24 hours after cataract surgery for about 2 weeks; refractive surgery: 1-2 drops pre-op, immediate post-op, then QID for up to 3 days | Postoperative inflammation, postoperative pain, photophobia |
| Ketorolac 0.5% | 1 drop QID starting 24 hours after cataract/refractive surgery for about 2 weeks; seasonal allergic conjunctivitis: 1 drop QID | Postoperative inflammation/pain, ocular pruritus |
Adverse Effects and Contraindications
- Burning/stinging, blurred vision, itching, lacrimation
- Delay in wound healing and keratitis risk
- Ocular bleeding risk including hyphema in susceptible clients
- Corneal epithelial breakdown, thinning, ulceration, or perforation risk with prolonged therapy
- Contraindicated with severe NSAID or aspirin hypersensitivity
Higher-risk corneal complications are more likely in clients with corneal denervation, dry-eye syndrome, diabetes, or rheumatoid arthritis, especially with treatment extending beyond about 14 days.
Nursing Assessment and Interventions
- Assess baseline and interval visual acuity.
- Monitor for ocular bleeding, facial edema, increasing pain, and corneal-injury cues.
- Require return-demonstration of drop technique and contamination prevention.
- Provide temporary fall-risk support if blurred vision affects ambulation safety.
- If corneal epithelial breakdown appears, stop the topical NSAID and escalate promptly.
Drug and Care Interactions
- Concurrent ophthalmic corticosteroids: higher delayed-healing risk
- Latanoprost: potential reduced latanoprost therapeutic effect
- Anticoagulants/antiplatelet pathways: additive bleeding risk context
Client Education
- Read labels carefully to avoid look-alike/sound-alike errors (for example ketorolac vs similarly named nonophthalmic products).
- Report red eye, foreign-body sensation, worsening pain, photophobia, or decreased vision promptly.
- Do not drive or operate hazardous equipment until vision clears after instillation.
- Avoid contaminating dropper tip by touching the eye, skin, or other surfaces.
Related Concepts
- ophthalmic-medication-administration - Sterile no-touch instillation and route safety.
- ophthalmic-corticosteroids - Commonly paired class with additive healing-risk concerns.
- ophthalmic-antibiotics - Postoperative anti-infective overlap and technique reinforcement.
- eye-assessment-visual-acuity-and-common-abnormalities - Vision-change reassessment in ocular drug therapy.