Acular (Ketorolac 0.5%)

Delayed healing: Topical NSAIDs may slow or delay healing; concomitant topical steroids compound the risk.

Cross-sensitivity: Potential cross-reactivity with acetylsalicylic acid, phenylacetic acid derivatives, and other NSAIDs. Bronchospasm and exacerbation of asthma have been reported in patients with aspirin or NSAID hypersensitivity or a past history of asthma.

Increased bleeding time: Interference with thrombocyte aggregation. Ocularly applied NSAIDs have been reported to increase bleeding of ocular tissues, including hyphema, in conjunction with surgery. Use caution with known bleeding tendencies or concomitant drugs that prolong bleeding time.

Corneal effects: Keratitis can occur, and continued use in susceptible patients may progress to epithelial breakdown, corneal thinning, erosion, ulceration, or perforation, which may be sight threatening. Discontinue immediately on corneal epithelial breakdown and monitor corneal health closely.

Higher-risk corneas: Complicated or repeat ocular surgery, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface disease such as dry eye, and rheumatoid arthritis raise the risk of sight-threatening corneal events.

Extended perioperative use: Dosing more than 1 day before surgery or beyond 14 days after surgery increases the occurrence and severity of corneal adverse events.

Contact lens wear: Not to be administered while wearing contact lenses.

Contamination risk: Bottle tip contact with the eye or surrounding structures can contaminate the solution and cause serious ocular infection and vision loss.