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topical NSAIDs useful for corneal abrasion, and by extension likely of use
for general ocular inflammation, include diclofenac (0.1%), flurbiprofen
(0.03%), and piroxicam (0.5%). 15–19 The only noted adverse effect in studies
of topical NSAIDs is transient (minor) stinging.
Ocular inflammation 307
An RCT illustrating NSAIDs’ utility in mechanical irritation addressed use
of indomethacin (0.1%) in painfully inflamed pterygia or pinguecula. Topical
indomethacin (0.1%) was significantly less painful than, and provided
equally good pain relief to, the topical corticosteroid dexamethasone phos-
phate (0.1%); both agents were administered six times daily for three days,
then QID for 11 days. 20
Topical NSAIDs also provide effective pain relief for allergic conjunctivitis.
Although there is probably little difference between various NSAIDs, indo-
methacin (0.1% QID) performs at least as well as, and may be associated with
earlier symptom relief than, ketorolac (0.5% QID). 7
The topical NSAIDs relieve pain in infectious conjunctivitis. In hemorrhagic
(presumably coxsackieviral) conjunctivitis treated with antibiotic drops, the
addition of piroxicam (0.5%, 1 drop QID) is associated with significant
improvement in pain as well as a variety of other endpoints. 21
As is the case with corneal abrasion, there are no studies on the use of oral
or parenteral NSAIDs in ocular inflammation. However, there is intuitive
basis for some benefit to their use, given the utility of topically administered
NSAIDs. There are few studies specifically addressing use of the topical
ophthalmic NSAIDs in children, but the available evidence suggests that
this class is safe in children. 22
When corticosteroids are to be applied topically for infectious conjunctivitis,
RCT evidence supports the use of dexamethasone. A trial comparing
combination therapy with BID-applied topical antibiotic (tobramycin, 0.3%)
and either dexamethasone (0.1%) or loteprednol (0.5%) found better pain
and symptom reduction with dexamethasone. 23 Corticosteroids applied
topically are also useful in exposures from land- and marine-based stinging
exposures such as from bees or coral. 24,25 Topical corticosteroids are anecdotally
useful adjuncts for ultraviolet keratitis, as they hasten the relief of
swelling and also tend to provide some relief from the burning pain and
photophobia that accompany this. 26