Corneal perforation associated with the use of Ketorolac Tromethamine after cataract surgery

Abstract Purpose To report a case of corneal ulceration and perforation after cataract surgery associated with normal doses of ketorolac tromethamine (Elipa®). Case-Report An eighty-year-old man with a 15-days history of right eye (RE) cataract surgery presented to our emergency department with complaints of pain and blurred vision. He was on a treatment regimen with a combination of dexamethasone plus gentacmicin given 5 times daily and ketorolac tromethamine given 3 times daily. The patient’s visual acuity was light perception. Slit-lamp examination of the right eye revealed central corneal perforation with iris prolapse and a shrunken eye. The drug was discontinued, a bandage soft contact lens was placed and topical antibiotics and preservative-free tears were added, with a slow improvement during the following weeks. Laboratory tests, including corneal cultures, were negative or normal. Conclusions Patients treated with topical NSAIDs drugs after ocular surgery should be monitored closely. The duration of treatment and frequency of administration should be minimized, and as needed, should be discouraged. Corneal melting or perforation is a rare complication that may occur in patients receiving topical NSAIDs. Even in patients without any such history of previous ocular surface disease, severe and unexpected complications may happen.