title: Keratitis, ulceration, and perforation associated with topical nonsteroidal anti-inflammatory drugs.
abstract: OBJECTIVE
  To report corneal complications associated with topical nonsteroidal anti-inflammatory drugs (NSAIDs).
  
  
  METHODS
  Retrospective, noncomparative interventional case series.
  
  
  METHODS
  Eighteen eyes of 16 patients with adverse corneal events associated with NSAID use.
  
  
  METHODS
  Evaluation of 16 patients referred for management of corneal complications during use of topical NSAIDs (ketorolac tromethamine [Acular], diclofenac sodium [Voltaren], diclofenac sodium [Falcon DSOS]).
  
  
  METHODS
  Type and severity of corneal complications.
  
  
  RESULTS
  Of the 16 patients, two experienced severe keratopathy, three experienced ulceration, six experienced corneal or scleral melts, and five experienced perforations. Eleven patients had recent cataract surgery; nine of these were on concurrent topical steroids and antibiotics. Another patient who did not have recent surgery was using concurrent topical steroids without antibiotics for sarcoid uveitis. Systemic associations included two patients with rheumatoid arthritis, one patient with asymptomatic Sjogren's syndrome, and two with rosacea.
  
  
  CONCLUSIONS
  Topical NSAIDs were associated with corneal complications in 18 eyes of 16 patients. Potential risk factors include conditions that predispose the patient to corneal melting, concurrent topical steroids, and epithelial keratopathy in the early postoperative period.
authors.affiliation: Department of Ophthalmology, Long Island Jewish Medical Center, New Hyde Park, New York, NY, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Guidera
authors.forename: J I
authors.initials: JI
authors.lastname: Luchs
authors.forename: I J
authors.initials: IJ
authors.lastname: Udell
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003315:Cornea / Q000187:drug effects* / Q000473:pathology; D003320:Corneal Ulcer / Q000139:chemically induced* / Q000473:pathology; D004008:Diclofenac / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000139:chemically induced / Q000473:pathology; D020911:Ketorolac Tromethamine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture / Q000139:chemically induced
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009883:Ophthalmic Solutions; D004008:Diclofenac; D020911:Ketorolac Tromethamine