How Do Ophthalmic NSAIDs Work?

Ophthalmic NSAIDs are non-steroidal anti-inflammatory drugs, a class of medications prescribed to treat or prevent eye inflammation. Ophthalmic NSAIDs relieve symptoms such as pain, redness and swelling from inflammation caused by certain eye conditions, injuries or ocular surgical procedures.

NSAIDs inhibit the activity of enzymes known as cyclooxygenases (COX-1 and COX-2) essential for the biosynthesis of prostaglandin. Prostaglandin is a fatty compound that plays an important role in initiating the inflammatory process which results in dilation and increased permeability of blood vessels, activation of immune cells and release of inflammatory substances.

Ophthalmic NSAIDs are not as potent at controlling inflammation as corticosteroids are, but they are effective for pain relief, have less serious side effects than steroids and do not compromise the immune system. NSAIDs may be used in combination with pupil-dilating (mydriatic) medications for some surgical procedures.

Ophthalmic NSAIDs are solutions or suspensions topically administered on the eye surface. Ophthalmic NSAIDs are used in eye conditions and surgical procedures which include the following:

• To treat allergic conjunctivitis, a condition caused by seasonal allergies which results in inflammation of the conjunctiva, the clear membrane over the whites of the eye and inner eyelid surfaces.
• To prevent pain from injury or infection in the eye
• To prevent pain and inflammation during and after ocular surgical procedures such as:
  • Cataract extraction and intraocular lens replacement
  • Corneal refractive surgery
• To prevent pupil contraction (miosis) during and after cataract surgery
• To prevent postoperative cystoid macular edema, a condition that affects the macula, the central portion of the retina

Side effects of ophthalmic NSAIDs may include:

Ocular side effects:

• Transient burning and stinging
• Dilation of blood vessels in the conjunctiva (conjunctival hyperemia)
• Corneal edema
• Inflammation of the iris (iritis)
• Inflammation of the conjunctiva (conjunctivitis)
• Conjunctival edema
• Accumulation of white blood cells in the cornea (corneal infiltrates)
• Ocular inflammation
• Irritation and foreign body sensation
• Ocular pain
• Increased intraocular pressure
• Superficial ocular infection
• Superficial inflammation of the cornea (keratitis)
• Corneal deposits
• Corneal ulcer
• Corneal erosion
• Corneal thinning
• Corneal perforation
• Breakdown or degeneration of epithelial cells in the cornea
• Blurred vision
• Dry eyes
• Abnormal sensation in the eye
• Itching and redness
• Delayed corneal wound healing
• Tearing (lacrimation)
• Eyelid swelling
• Scar tissue formation (fibrosis)
• Hyphema in which blood collects in the eye’s anterior chamber (the space between the cornea and lens normally filled with clear fluid)
• Anterior chamber inflammation
• Pupil contraction (miosis)
• Pupil dilation (mydriasis)
• Increased tendency for bleeding in the eye tissue after surgery
• Increased bleeding time
• Opacity of the posterior part of the membrane that encapsulates the lens (posterior capsule opacification)
• Reduced visual acuity
• Sticky sensation
• Eyelid margin crusting
• Light sensitivity
• Dilation of blood vessels in the eye (ocular hyperemia)
• Vitreous detachment, a condition in which the vitreous (gel-like substance that fills the eyeball) separates from the retina

Systemic side effects:

• Bronchospasm
• Aggravation of asthma
• Headache
• Dizziness
• Sleeplessness (insomnia)
• Pain
• Fever
• Chills
• Nausea and vomiting
• Abdominal pain
• Hypertension

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand name of some ophthalmic NSAIDs include:

• Ketorolac tromethamine ophthalmic (Acular, Acular LS, Acuvail)
• Bromfenac sodium ophthalmic (BromSIte, Prolensa)
• Diclofenac sodium ophthalmic (Voltaren Ophthalmic)
• Flurbiprofen sodium ophthalmic
• Nepafenac ophthalmic (Nevenac, Ilevro)

Combination of NSAID and mydriatic drug

• Ketorolac tromethamine/phenylephrine hydrochloride ophthalmic (Omidria)