Topical nonsteroidal anti-inflammatory drugs for ophthalmic use: a safety review.

摘要: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used agents that despite chemically heterogeneity, share similar therapeutic properties and adverse effects. Topical ophthalmic NSAIDs limited to the relatively water soluble phenylacetic phenylalkanoic acids as well indole derivatives, which more suitable for use. commonly in treatment of post-operative inflammation following cataract extraction various surgical refractive procedures. They also prevention cystoid macular oedema allergic conjunctivitis. Absorption topical through nasal mucosa results systemic exposure occurrence events, including exacerbation bronchial asthma. Local irritant effects include conjunctival hyperaemia, burning, stinging corneal anaesthesia. A serious complication involves association with indolent ulceration full-thickness melts. Analysis NSAID-associated events implicates now defunct generic dicolfenac product, diclofenac sodium solution agent primarily responsible. However, these generated a renewed interest safety scrutiny pharmacology regarding NSAID action eye. An elucidation possible pharmacodynamic explanations NSAID-induced injury includes role epithelial hypoxia, not only appears aid determining metabolic destination arachidonate, it may play key orchestrating novel inflammatory response unrelated prostanoid formation. The use under conditions hypoxia therefore result disappointing response, paradoxical exacerbation. Other potential mechanisms relationship between matrix metalloproteinase direct toxicity due cytotoxic excipients such surfactants, solubilisers preservatives found preparations. In general, be safely other pharmaceuticals; however, concurrent known adversely effect epithelium, gentamicin, lead increased penetration NSAID. corticosteorids face significant pre-existing has been identified risk factor precipitating erosions melts should undertaken caution. Until clinical evidence dictates otherwise, data supporting theories do alter favorable benefit-risk ratio when employed an appropriate judicious manner.