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Topical ophthalmic NSAIDs reduce pain faster than placebo

J Fam Pract. 2003 June;52(6):431-454
By
Bruce R. Deschere, MD, MSBA
Kendra Schwartz, MD, MSPH
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  • BACKGROUND: Corneal abrasions are common in primary care and emergency practices, and the pain can be quite disabling. Standard acute treatment includes cycloplegics and topical anesthetics; patients are often discharged with oral narcotic analgesics. Topical ophthalmic NSAIDs are an alternative to oral analgesics.
  • POPULATION STUDIED: The authors reviewed the use of topical ophthalmic NSAIDs for simple corneal abrasions in adult patients presenting to emergency departments. Two studies were performed in the United States; 3 in Europe. Exclusion criteria were serious injuries or complicating factors including other eye pathology, use of contact lenses, and pregnancy. Gender, race, and median age of subjects were not provided.
  • STUDY DESIGN AND VALIDITY: This critical appraisal update searched only English-language databases available through OVID and found 6 randomized double-blinded studies comparing NSAIDs with placebo topical ophthalmic solutions, containing either ketorolac, diclofenac, or indomethacin. One study was not included because it used contact lenses as a co-intervention.
  • OUTCOMES MEASURED: The primary outcome was pain, measured using an analog pain scale that compared pain at baseline and at designated intervals. Two used a visual analog scale of 0 to 100, one used a visual analog scale of 0 to 5, one used a “scale” of 0 to 10, and one used a Numeric Pain Intensity Score of 0 to 10. One study noted pain intensity as soon as 1 hour after start of treatment, one study at 2 hours, and 3 studies reviewed pain relief 1 day after treatment started.
  • RESULTS: Treatment and control subjects had similar corneal healing time. Based on the analog pain scales, patients receiving the NSAIDs achieved relative pain relief more quickly than those receiving placebo.
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PRACTICE RECOMMENDATIONS

Topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) relieve the pain of uncomplicated acute corneal abrasions faster than placebo eyedrops.

The pain relief is small; whether the pain relief difference would be noticed by patients and how it compares with oral analgesics is unknown. Given the cost of topical NSAIDs, they are most useful for a select patient population: those who must return to work immediately, and those for whom opioid analgesia-induced sedation is intolerable.

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