NSAID Eye Drops: Ketorolac 0.5% Dosing and Duration

Safety Concerns with Extended Use

The American College of Rheumatology notes that all topical NSAIDs carry risk of severe corneal complications, including keratitis, with continued use beyond recommended duration 1
The American College of Rheumatology also reports that corneal thinning, corneal erosion, corneal ulceration, and corneal perforation are potential risks of extended topical NSAID use, with corneal erosion and corneal ulceration being specifically associated with topical NSAID use 2

The American Academy of Ophthalmology suggests that nepafenac 0.1% can be used three times daily for 4 weeks or until complete subretinal fluid resolution for acute central serous chorioretinopathy, although the evidence base is limited and more robust studies are needed before routine clinical use 3

The American College of Rheumatology recommends that ketorolac can be safely administered with other ophthalmic medications, including antibiotics and beta blockers, with no significant interactions reported 2, 4

The American College of Rheumatology advises considering steroid alternatives, such as topical glucocorticoids, for chronic inflammatory conditions requiring treatment beyond 2-4 weeks, as they are conditionally recommended for longer-term control in conditions like juvenile idiopathic arthritis-associated uveitis, with a moderate strength of evidence 1, 2, 4, 5

The American Academy of Ophthalmology recommends ketorolac for temporary relief of ocular itching caused by seasonal allergic conjunctivitis, as a second-line treatment option after dual-action agents 6
Nepafenac 0.1% ophthalmic solution has been studied for treating acute central serous chorioretinopathy, applied three times daily for 4 weeks or until complete subretinal fluid resolution 7, 8
Topical NSAIDs are recommended for use within the first post-surgical month following cataract surgery as part of preservative-free eye-drop regimens, according to the American Academy of Ophthalmology 9, 10
All topical NSAIDs may result in keratitis, corneal thinning, corneal erosion, corneal ulceration, and corneal perforation with continued use, as warned by the National Institute of Health 11, 12
The maximum recommended duration is 2-4 weeks for topical NSAIDs in ocular dryness management to avoid serious adverse events, as recommended by the European League Against Rheumatism 11, 12