Non-steroidal anti-inflammatory drugs (NSAIDs): ocular pharmacology, pharmaceutical innovations, and drug delivery perspectives

Ocular nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used as safer alternatives to corticosteroids for managing anterior segment inflammation and pain. By inhibiting cyclooxygenase (COX) enzymes and prostaglandin synthesis, NSAIDs effectively reduce post-operative inflammation, allergic conjunctivitis, and intraoperative miosis during cataract surgery. Limited clinical evidence suggests benefits in preventing cystoid macular edema (CME), whereas experimental studies indicate potential therapeutic roles in retinal disorders such as diabetic retinopathy (DR), age-related macular degeneration (AMD), and diabetic macular edema (DME) through anti-angiogenic and neuroprotective mechanisms. Commonly used agents include diclofenac, indomethacin, ketorolac, bromfenac, flurbiprofen, and nepafenac, primarily formulated as topical ophthalmic solutions or suspensions. Compared to corticosteroids, NSAIDs do not raise intraocular pressure or induce cataracts, though mild adverse effects (such as burning, hyperemia, and keratitis) may occur; more severe complications like corneal melt are rare. This review provides a comprehensive analysis of NSAIDs in ophthalmology, covering their pharmacology, clinical applications, safety, delivery innovations, and future perspectives, including advanced formulations and emerging strategies to enhance their effectiveness in management of inflammatory ocular disorders.