Nepafenac

How it works

It is a prodrug that is converted within ocular tissues to amfenac, which inhibits cyclo-oxygenase and thereby reduces prostaglandin synthesis, decreasing inflammation and pain.

Prescribing in practice

• Topical ocular NSAIDs can rarely cause corneal adverse effects such as keratitis or corneal melt, with greater risk in patients with corneal epithelial breakdown, ocular surface disease or concurrent corticosteroid use.
• Use with caution in patients with known hypersensitivity to other NSAIDs, including aspirin.
• It may mask the signs of an ongoing eye infection, so infection should be excluded.

Monitoring

Patients should be monitored clinically for corneal integrity and resolution of inflammation, particularly with prolonged use or in at-risk eyes.

Counselling the patient

• Report any new eye pain, increasing redness or change in vision promptly.
• Tell your clinician if you have had a previous reaction to aspirin or other anti-inflammatory medicines.
• Use the drops only for the period advised after your surgery.

Evidence & guidelines

Topical NSAIDs are an established adjunct for managing inflammation after cataract surgery, with efficacy and corneal safety considerations described in the SPC and ophthalmology guidance.