Ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) prevent the synthesis of prostaglandins responsible for changing intraocular pressure and causing miosis and vasodilation resulting in inflammation. Currently, these products are indicated for the treatment of pain and inflammation associated with cataract surgery, pain associated with corneal refractive surgery, inhibition of intraoperative miosis, and seasonal allergic conjunctivitis. Published in the Annals of Pharmacotherapy, a recent review compared published data from 67 articles on the efficacy of diclofenac, ketorolac, flurbiprofen, bromfenac, and nepafenac within and outside their FDA-approved uses. After assessing the data, the authors made the following recommendations:

Pain and Inflammation Associated With Cataract Surgery

Recommended Options

  • Diclofenac 0.1% 4 times daily
  • Ketorolac 0.4% 4 times daily
  • Bromfenac 0.09% once or twice daily
  • Ketorolac 0.45% 2 times daily
  • Nepafenac 0.3% once daily
  • Bromfenac 0.07% once daily

Additional Options

  • Ketorolac 0.5% 4 times daily
  • Nepafenac 0.1% 3 times daily

For patients with adherence concerns, bromfenac 0.09% once daily, ketorolac 0.45% twice daily, nepafenac 0.3% once daily or bromfenac 0.07% once daily are recommended. Diclofenac 0.1% 4 times daily is also recommended as an additional option since previous research has been shown that when three pre-op doses are given, the drug may be effective with as little as once-daily post-op dosing.