drug is probably secreted in the tears, thereby causing corneal deposits, irritation and occasionally a keratitis. Intracranial hypertension and optic neuritis have been reported with indometacin use.

Keratorefractive surgery has brought topical ocular indometacin back into clinical use in large part because it has fewer side effects than steroids. Its main use is as a local anesthetic, showing less damage to the corneal epithelium (Badalá et al 2004) in the immediate post-operative period. Sheehan and Kutzner (1989) reported a case of possible acute asthma due to topical ocular indometacin.

References and Further Reading

Badalá F, Fiorett M, Macrí A. Effect of topical 0.1% indomethacin solution versus 0.1% fluorometholon acetate on ocular surface and pain control following laser subepithelial keratomileusis (LASEK). Cornea 23:

550–553, 2004.

Birch J, et al. Acquired color vision defects. In: Congenital and Acquired Color Vision Defects, Pokorny J, et al. Grune & Stratton, New York, 1979, pp 243–350.

Burns CA. Indomethacin, reduced retinal sensitivity, and corneal deposits. Am J Ophthalmol 66: 825–835, 1968.

Carr RE, Siegel IM. Retinal function in patients treated with indomethacin. Am J Ophthalmol 75: 302–306, 1973.

Fraunfelder FT, Samples JR, Fraunfelder FW. Possible optic nerve side effects associated with nonsteroidal anti-inflammatory drugs. J Toxicol Cut Ocular Toxicol 13(4): 311–316, 1994.

Frucht-Pery J, Levinger S, Zauberman H. The effect of topical administration of indomethacin on symptoms in corneal scars and edema. Am J Ophthalmol 112(2): 186–190, 1991.

Frucht-Pery J, Siganos CS, Solomon A, et al. Topical indomethacin solution versus Dexamethasone solution for treatment of inflamed pterygium and pinguecula: a prospective randomized clinical study. Am J Ophthalmol 127: 148–152, 1999.

Gimbel HW. The effect of treatment with topical nonsteroidal anti-inflam- matory drugs with and without intraoperative epinephrine on the maintenance of mydriasis during cataract surgery. Ophthalmology 96(5): 585–588, 1989.

Gomez A, Florido JF, Quiralte J, et al. Allergic contact dermatitis due to indomethacin and diclofenac. Contact Dermatitis 43: 59, 2000.

Graham CM, Blach RK. Indomethacin retinopathy: case report and review. Br J Ophthalmol 72: 434–438, 1988.

Henkes HE, van Lith GHM, Canta LR. Indomethacin retinopathy. Am J Ophthalmol 73: 846–856, 1972.

Katz IM. Indomethacin. Ophthalmology 88: 455, 1981.

Katzman B, Lu L, Tiwari RP, et al. Pseudotumor cerebri: an observation and review. Ann Ophthalmol 13: 887, 1981.

Palimeris G, Koliopoulos J, Velissaropoulos P. Ocular side effects of indomethacin­ . Ophthalmologica 164: 339–353, 1972.

Procianoy RS, Garcia-Prats JA, Hittner HM, et al. Use of indomethacin and its relationship to retinopathy of prematurity in very low birthweight infants. Arch Dis Child 55: 362–364, 1980.

Rich LF. Toxic drug effects on the cornea. J Toxicol Cut Ocular Toxicol I: 267, 1982–1983.

Sheehan GJ, Kutzner MR. Acute asthma attack due to ophthalmic indocin. Ann Int Med 111: 337–338, 1989.

Toler SM. Oxidative stress plays an important role in the pathogenesis of drug-induced retinopathy. Exp Biol Med 229: 607–615, 2004.

Yoshizumi MO, Schwartz S, Peterson M. Ocular toxicity of topical ­indomethacin eye drops. J Toxicol 10(3): 201–206, 1991.

Primary use

This non-steroidal anti-inflammatory drug with antipyretic and analgesic properties is used in the treatment of rheumatoid ­arthritis, osteoarthritis, ankylosing spondylitis and gout.

Ocular side effects

Systemic administration

Probable

1. Eyelids or conjunctiva

a.Erythema

b.Conjunctivitis – non-specific

c.Edema

d.Discoloration

e.Photosensitivity

f.Urticaria

g.Purpura

h.Contact dermatitis

i.Angioneurotic edema

2. Non-specific ocular irritation

a.Hyperemia

b.Ocular pain

3. Visual hallucinations

Possible

1. Subconjunctival or retinal hemorrhages – secondary to systemic­ anemia

2. Decreased vision

3. Keratoconjunctivitis sicca

4. May aggravate the following disease

a.Myasthenia gravis

b.Herpes infections 5. Eyelids or conjunctiva

a.Exfoliative dermatitis

b.Eczema

Conditional/Unclassified

1. Paralysis of extraocular muscles

Clinical significance

Ketoprofen rarely causes ocular problems. There has only been one case each of intracranial hypertension or a possible optic neuritis reported to the National Registry, so a causative relationship is highly unlikely. Ketoprofen, however, has been associated with precipitating cholinergic crises. It has also been associated with herpes simplex activation systemically and ocularly. We are not convinced that this agent causes keratoconjunctivitis sicca. However, since the drug is secreted in the tears, it would have the potential to aggravate patients with borderline sicca or those with pre-existing sicca. This agent is a photosensitizing agent may cause ocular phototoxicity. There is only one report (McDowell and McConnell 1985) of precipitating a cholinergic crisis in a patient with myasthenia gravis.

Generic name: Ketoprofen.

Proprietary name: Oruvail.

References and Further Reading

Alomar A. Ketoprofen photodermatitis. Contact Dermatitis 12: 112, 1985.

Dukes MNG (ed). Meyler’s Side Effects of Drugs, Vol. X. Excerpta Medica, Amsterdam, p 163, 1984.

Fraunfelder FT, Samples JR, Fraunfelder FW. Possible optic nerve side effects associated with nonsteroidal anti-inflammatory drugs. J Toxicol Cut Ocular Toxicol 13(4): 311–316, 1994.