Ocular and systemic adverse effects of topical non-steroidal anti-inflammatory drugs ‒ a narrative review with quantitative synthesis

Abstract

Introduction and aim. The impacts of topical ophthalmic non-steroidal anti-inflammatory drugs (NSAIDs) have been studied, with instances of an unprecedented quantitative assessment of adverse drug reaction prevalence among several NSAID classes. This study aimed to systematically observe and synthesize the relevant information on the pharmacodynamic mechanism of adverse drug reactions (ADR) corresponding to topical NSAID administration. Material and methods. A preliminary search on PubMed Central, Google Scholar, and ScienceDirect databases yielded 83 articles. Analysis of literature. Conditions such as corneal perforation, ulceration, infiltration, keratitis, melt, corneal issues involving epithelial defects, tissue loss, stromal thinning, and delayed wound healing accentuate a comprehensive range of consequences on corneal integrity and physiology. The topical NSAID group also conveys more diversified systemic adverse reactions involving dilated ventricle, tricuspid regurgitation, pulmonary insufficiency, closure of the ductus arteriosus, and prenatal ductal constriction, which constitute a concern for their impact on cardiac activity and developing embryos. Conclusion. Burning sensation is reported to be the most commonly reported frequency after photophobia. Notably, preferential COX-2 inhibitors had a significantly greater prevalence of ADRs than both nonselective COX inhibitors (mean difference=1.05, p=0.023) and selective COX-2 inhibitors. Longitudinal studies with frequent follow-ups are essential to fully characterize the incidence, severity, and long-term effects of adverse consequences.