This Page Intentionally Left Blank - Int Medical

306
Ocular inflammation
STEPHEN H. THOMAS
n Agents
n NSAIDs
n Corticosteroids
n Antihistamines
n Decongestants
n Mast cell stabilizers
n Local anesthetics
n Cycloplegics
n Opioids
n Evidence
This chapter addresses ocular inflammatory conditions such as conjunctivitis
(allergic and infectious) and keratitis. Related information on topical anesthetics
is found in the chapter on corneal abrasion. This chapter does not
address systemic therapy for disease-specific causes of ocular pain (e.g.
cyclosporine [ciclosporin] for ocular pemphigoid). 1 This discussion also
does not include general care measures (e.g. irrigation for chemical exposures),
which may contribute to, or completely achieve, pain relief. 2,3
General guidelines for treating ocular inflammation of both infectious and
noninfectious origin emphasize the utility of topical NSAIDs, which avoid the
complications (e.g. local immunocompromise) of the traditional topical
alternative, corticosteroids. 4,5 Furthermore, the effective application of
these topical agents can reduce or eliminate the need for potent systemic
therapy such as opioids.
For nearly all types of ocular inflammatory pain, ranging from traumatic
inflammation to edema to allergic conjunctivitis, the topical NSAIDs have
proven useful. 6–8 Ketorolac (0.5%) and indomethacin (0.1%) are the moststudied
agents, with significant efficacy compared with placebo. 9–14 Other