Effects of the topical treatment with NSAIDs on corneal sensitivity and ocular surface of Sjögren's syndrome patients

Abstract

Aim and purpose To evaluate the effects of two NSAIDs on corneal sensitivity and ocular surface in Sjö gren's syndrome (SS) patients. Methods In all, 20 SS patients with epithelial corneal defects, were randomly divided into two groups: group 1 (10 females, age 35-63 years), treated with 0.1% indomethacin, one drop three times a day; group 2 (nine females, one male, age 38-65 years) treated with 0.1% diclofenac, at the same regimen. No systemic NSAIDs were allowed. Use of tear substitute was allowed. Corneal sensitivity, corneal staining, BUT, and ocular discomfort, were evaluated before and after 15, 30 days of treatment and 7 days after NSAID discontinuation. For statistical analysis, the Student's t-test and Mann-Whitney U test were used.

Corneal Ulceration and Perforation With Ketorolac Tromethamine (Acular®) Use After PRK

“…14-16 Nonsteroidal antiinflammatory drugs are thus associated with a significant decrease in corneal sensation, delaying early corneal wound healing and reepithelialization. 5,[17][18][19][20] Alternative mechanisms have been proposed by which NSAIDs may induce corneal melting, including the upregulation of matrix metalloproteinases (MMPs). Increased MMP production by invading inflammatory cells and resident corneal cells leads to overexpression of interstitial collagenase MMP-1, PMN leukocyte collagenase MMP-8, and gelatinase A MMP-2.…”

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“…Loteprednol dosed twice daily has also been shown to help patients transition to cyclosporin-A treatment by reducing the sting that usually accompanies the use of cyclosporine-A [46]. In addition to steroids topical NSAID's have been shown to be useful in resolving symptoms of ocular discomfort in SS patients [47], but should not be used for long periods of time because of the risk associated with corneal perforation [48].…”

Safety of treatments for primary Sjögren’s syndrome

“…[30][31][32] Inhibition of prostaglandins and the arachidonic acid cascade by topical NSAIDs can relieve ocular hyperalgesia. However, in patients with corneal problems, a common phenomenon in pSS patients, the use of topical NSAIDs is associated with corneal-scleral melts, perforation, and severe keratopathy.…”