The role of nonsteroidal antiinflammatory drugs in ocular inflammation

In the treatment of ocular inflammation, the appeal of nonsteroidal antiinflammatory drugs (NSAIDs) hinges on the complications associated with the more established therapy for ocular inflammation: corticosteroids. Although an overlap between the mechanisms of action of both NSAIDs and corticosteroids exists, the use of topical NSAIDs may be safer than the use of corticosteroids, as the latter may produce adverse effects such as glaucoma, opportunistic infections, and posterior subcapsular cataracts. In sharp contrast, topical NSAIDs are known to cause only minor adverse effects such as burning, stinging, and hyperemia of the conjunctiva [1]. Therefore, in the treatment of ocular inflammation, the goal of treating with oral and topical NSAIDs is to reduce or even eliminate steroid use. In this chapter, we review the uses of NSAIDs in the treatment of noninfectious ocular inflammation. The evidence supporting the therapeutic efficacy of both topical and oral NSAIDs in conditions such as allergic conjunctivitis, keratopathy, uveitis, postoperative inflammation, and cystoid macular edema are addressed. The use of NSAIDs in preventing intraoperative miosis, and the pharmacokinetics and pharmacodynamics of these agents are not discussed.