Beyond Steroids: What Veterinarians Should Know About Topical Ketorolac in Canine Uveitis

Anterior uveitis remains one of the most commonly encountered ocular inflammatory conditions in small animal practice. While corticosteroids continue to be the cornerstone of therapy, clinicians are often faced with cases where alternative or adjunctive anti-inflammatory options become necessary. This is especially relevant in patients with corneal ulceration risk, steroid sensitivity, glaucoma concerns, or the need for prolonged treatment¹. 

Recent findings suggest that topical ketorolac tromethamine may offer anti-inflammatory efficacy comparable to flurbiprofen in canine anterior uveitis, giving veterinarians another potential option for managing ocular inflammation in dogs. 

Why Early Inflammation Control Matters 

The inflammatory cascade in anterior uveitis is driven largely by prostaglandins, particularly PGE2, which increases vascular permeability within the blood-aqueous barrier and promotes cellular and protein influx into the aqueous humor. Clinically, this manifests as pain, aqueous flare, miosis, hypotony, and in severe cases, glaucoma, retinal degeneration, and blindness^1,2. 

Although topical non-steroidal anti-inflammatory drugs (NSAIDs) are not typically considered replacements for corticosteroids, they remain valuable adjuncts in veterinary ophthalmology. Among ophthalmic NSAIDs, flurbiprofen has traditionally been more widely discussed, while ketorolac has comparatively limited canine-specific data despite its extensive use in human ophthalmology^1,3. 

Evaluating Ketorolac in Experimental Uveitis 

To better understand its clinical utility, researchers evaluated the effects of 0.5% ketorolac tromethamine compared with 0.03% flurbiprofen in dogs with experimentally induced uveitis. 

The study used a crossover design in 10 healthy adult dogs. Uveitis was induced through anterior chamber paracentesis, a recognized model for disrupting the blood-aqueous barrier and triggering ocular inflammation¹. 

Each dog received: 

• 0.5% ketorolac tromethamine in one eye  

• 0.03% flurbiprofen in the opposite eye after a washout period  

To objectively assess inflammation, aqueous humor samples were analyzed for: 

• PGE2 concentrations using competitive enzyme immunoassay  

• Drug concentrations using high-performance liquid chromatography (HPLC)  

Intraocular pressure (IOP) was also monitored over a 60-hour period. 

What the Findings Mean in Practice¹ 

One of the most clinically relevant findings was the significant reduction in PGE2 levels following treatment with both medications. Mean PGE2 concentrations increased dramatically after uveitis induction, rising from 65.07 pg/mL at baseline to 9308.68 pg/mL. Following treatment, levels decreased to 174.81 pg/mL with ketorolac and 189.3 pg/mL with flurbiprofen, with no statistically significant difference between the two therapies. 

For clinicians, this suggests that ketorolac achieved meaningful suppression of intraocular inflammation comparable to flurbiprofen. 

The study also confirmed measurable penetration of both drugs into the aqueous humor. Ketorolac concentrations reached 27.04 ± 14.348 ng/mL, while flurbiprofen concentrations measured 25.41 ± 16.93 ng/mL. Detectable intraocular concentrations are particularly important because adequate anterior chamber penetration directly influences anti-inflammatory efficacy. 

Interestingly, intraocular pressure did not significantly decrease despite experimental uveitis induction. The authors suggested that the timing of IOP assessment, combined with the anti-inflammatory effects of both medications, may have helped stabilize the blood-aqueous barrier before clinically significant hypotony developed. 

Where Ketorolac May Fit in Clinical Settings 

For practicing veterinarians, ketorolac may be especially useful in situations where steroid use is limited or where additional anti-inflammatory support is needed. Potential clinical applications may include: 

• Mild-to-moderate anterior uveitis  

• Postoperative ocular inflammation  

• Steroid-sparing treatment protocols  

• Long-term inflammatory management  

An important practical aspect of the study was that ketorolac was administered after uveitis induction rather than prophylactically. This better reflects real-world clinical practice, where inflammatory episodes are often unpredictable and treatment begins after clinical signs develop. 

Looking Ahead 

The findings reinforce the growing interest in topical ketorolac as a useful ophthalmic NSAID in dogs. Its comparable anti-inflammatory performance to flurbiprofen, along with measurable aqueous humor penetration, suggests that it may become an increasingly valuable component of multimodal ocular inflammation management. 

Further studies evaluating naturally occurring uveitis and long-term clinical outcomes will help clarify its broader role in veterinary ophthalmology, but current evidence indicates that ketorolac deserves greater consideration in canine ocular anti-inflammatory protocols. 

References 

1. Teixeira CF, Rossetto VJ, Ferreira JC, Moreto F, Neto FJ, Zanuzzo FS, Brandão CV, Quitzan JG. Experimental Uveitis in Dogs-Comparison of Topical Ketorolac Tromethamine Versus Flurbiprofen. Acta Scientiae Veterinariae. 2026 Feb 3;54. https://seer.ufrgs.br/ActaScientiaeVeterinariae/article/download/145940/98467 

2. Shafiee A, Bowman LM, Hou E, Hosseini K. Aqueous humor penetration of ketorolac formulated in DuraSite or DuraSite 2 delivery systems compared to Acular LS in rabbits. Journal of ocular pharmacology and therapeutics. 2013 Nov 1;29(9):812-6. https://doi.org/10.1089/jop.2013.0016 

3. Schoenberger SD, Kim SJ, Sheng J, Calcutt MW. Reduction of vitreous prostaglandin E2 levels after topical administration of ketorolac 0.45%. JAMA ophthalmology. 2014 Feb;132(2). https://jamanetwork.com/journals/jamaophthalmology/articlepdf/1779720/eoi130191.pdf