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NSAID — Topical Ophthalmic Pregnancy: Avoid — NSAIDs in pregnancy; minimal systemic absorption from topical but caution advised

Diclofenac 0.1% Eye Drops

Brand names: Voltarol Ophtha, Diclofenac Sodium 0.1% Eye Drops

Adult dose

Dose: 1 drop four times daily (post-operative inflammation); 1 drop 30–60 minutes before surgery (intraoperative miosis prevention)
Route: Topical (ophthalmic)
Frequency: Four times daily post-operatively
Max: 1 drop per dose
Used for post-cataract inflammation and pain, and seasonal allergic conjunctivitis. Pre-operative use (3 doses on day of surgery before ophthalmology procedure) prevents intraoperative miosis. Phacoemulsification (ultrasound energy) during cataract surgery can cause prostaglandin-mediated pupil constriction — NSAIDs prevent this.

Paediatric dose

Route: Topical
Frequency: Four times daily
Max: Same as adult
Limited paediatric data; used in paediatric cataract surgery post-operatively under specialist guidance

Dose adjustments

Renal

No adjustment — topical use

Hepatic

No adjustment

Clinical pearls

  • Intraoperative floppy iris syndrome (IFIS): diclofenac pre-operative drops given every 30 minutes for 90 minutes before cataract surgery reduces prostaglandin-mediated pupil constriction — one component of managing miosis risk (alongside phenylephrine)
  • Seasonal allergic conjunctivitis: diclofenac 0.1% provides symptomatic relief for allergic conjunctivitis — less frequently used now that olopatadine (dual antihistamine + mast cell stabiliser) provides more complete allergic pathway blockade
  • Corneal melting: MHRA safety concern applies equally to diclofenac — risk highest in patients with pre-existing corneal disease, dry eye, rheumatoid arthritis with secondary keratoconjunctivitis sicca; examine ocular surface before prescribing
  • Post-cataract regimen: many UK cataract surgeons use a regimen of topical steroid + topical NSAID for 4 weeks post-operatively — evidence supports combination providing better outcomes than either alone for CME prevention
  • Preservative (BAK) in diclofenac: most formulations contain BAK — for patients requiring long-term NSAID use (e.g., chronic uveitis-related CME), consider switching to preservative-free alternatives

Contraindications

  • NSAID/aspirin hypersensitivity
  • Corneal epithelial defects — delays healing
  • Active herpes simplex keratitis

Side effects

  • Stinging and burning on instillation
  • Corneal epithelial toxicity — particularly with prolonged use
  • Corneal melting (rare — higher risk in compromised ocular surface)
  • Increased bleeding tendency at surgical site

Interactions

  • Other topical NSAIDs — additive corneal toxicity
  • Topical steroids — may reduce anti-inflammatory synergy if not used concurrently

Monitoring

  • Corneal integrity — fluorescein staining at each visit
  • Symptom response
  • OCT — CME if high-risk post-cataract

Reference: BNFc; BNF 90; MHRA NSAIDs Corneal Melting Warning; ESCRS Cataract Surgery Guidelines; SPC Voltarol Ophtha. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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