Allergic conjunctivitis NSAID

If mast cell stabilizers or multiple-action agents are not successful, a trial of a topical NSAID is appropriate. Ketorolac is the only approved topical agent for ocular itching. NSAIDs do not mask ocular infections, affect wound healing, increase intraocular pressure, or contribute to cataract formation like the topical corticosteroids. However, for allergic conjunctivitis, topical ketorolac is not as effective as olopatadine or emedas-tine in trials.15 Full efficacy of ketorolac takes up to 2 weeks.17... 

Action NSAID Dose 1 gtt qicl Caution [C, +] Disp Opthal soln SE Local irritation EMS None OD Unlikely to cause life-threatening Sxs Ketotifen (Zaditor) [Ophthalmic Anrihistamine/Histamine Antagonist Mast Cell Stabilizer] Uses Allergic conjunctivitis Action Hrreceptor antagonist, mast cell stabilizer Dose Adults Peds. 1 gtt in eye(s) q8—12h Caution [C, /—] Disp Soln SE Local irritation, HA, rhinitis EMS None OD Unlikely to cause life-threatening Sxs... 

Ketorolac This drug acts like the other NSAIDs. In addition to the oral route, ketorolac [key TOE row lak] can be administered intramuscularly in the treatment of postoperative pain, and topically for allergic conjunctivitis. Ketorolac undergoes hepatic metabolism the drug and its metabolites are eliminated via the urine. It causes the same side effects as the other NSAIDs. 

Various nonsteroidal anti-inflammatory drugs (NSAIDs) have been studied for potential clinical use in allergic conjunctivitis. Specifically, ketorolac tromethamine 0.5% has been found to be beneficial in treating SAC and is currently the only NSAID approved for topical treatment of SAC. 

In moderate to severe cases of allergic conjunctivitis, treatment considerations also include mast cell stabilizers, antihistamine-mast cell stabilizer combinations, oral antihistamines, NSAIDs, and, in severe cases, topical steroids. 

Other treatment options include the use of topical NSAIDs, which provide relief of itching. Ketorolac tromethamine (Acular) is the only NSAID approved for the treatment of seasonal allergic conjunctivitis, with symptomatic relief occurring within 30 minutes after administration.Topical NSAIDs are not typically the treatment option chosen, because the other classes of drugs provide better well-established relief. 

Ketorolac (administered as the tromethamine salt Toradol, Ultram) has been used as a short-term alternative (less than 5 days) to opioids for the treatment of moderate to severe pain and is administered intramnscnlarly, intravenously, or orally. Unlike opioids, tolerance, withdrawal, and respiratory depression do not occur. Like other NSAIDs, aspirin sensitivity is a contraindication to the nse of ketorolac. Typical doses are 30 to 60 mg (intramnscnlar), 15 to 30 mg (intravenous), and 5 to 30 mg (oral). Ketorolac is used widely in postoperative patients, but it should not be used for routine obstetric analgesia. Topical (ophthalmic) ketorolac is FDA approved for the treatment of seasonal allergic conjunctivitis and postoperative ocular inflammation after cataract extraction. 

---