Pain Management Eye Drops

Concise summaries of topical ocular analgesics and procedural anaesthetics used in optometric and ophthalmological practice in Singapore, including NSAIDs for post-operative pain, corneal abrasion management, and topical anaesthetics for clinical procedures.

Last updated: March 2026

What are topical ocular pain medications?

Topical ocular pain medications are pharmaceutical preparations applied directly to the ocular surface to manage pain arising from corneal pathology, surgical intervention, or clinical procedures. They fall into two mechanistically distinct categories: non-steroidal anti-inflammatory drugs (NSAIDs), which reduce prostaglandin-mediated pain and inflammation at the ocular surface and in the anterior segment; and topical anaesthetics, which produce rapid, temporary corneal anaesthesia for clinical examination and minor procedures.

In Singapore, topical NSAIDs are encountered most frequently in the context of the high volume of refractive surgery — particularly photorefractive keratectomy (PRK) and laser-assisted subepithelial keratectomy (LASEK) — performed at ophthalmologic practices and refractive surgery clinics. Post-cataract surgery inflammation management and cystoid macular oedema (CME) prophylaxis are additional major indications. Topical anaesthetics are a cornerstone of routine optometric clinical procedures, including applanation tonometry and gonioscopy.^[1,3]

Drug classes

Topical NSAIDs (COX inhibitors) — inhibit cyclo-oxygenase enzymes (COX-1 and COX-2) in the ocular surface, reducing prostaglandin E2 synthesis to produce analgesia, anti-inflammatory, and anti-miotic effects; used for post-operative pain, corneal abrasion analgesia, and CME prevention (e.g., diclofenac, ketorolac, nepafenac).
Topical anaesthetics (ester-type local anaesthetics) — block voltage-gated sodium channels in corneal nerve endings, producing rapid, reversible surface anaesthesia; used exclusively in-clinic for tonometry, gonioscopy, foreign body removal, and contact lens–related procedures; never for patient self-administration (e.g., proxymetacaine, tetracaine).

Who are they for?

Topical ocular pain medications serve patients across a wide clinical spectrum — from those undergoing routine intraocular pressure assessment to patients recovering from refractive or cataract surgery. Singapore's exceptionally high refractive surgery uptake and its large contact lens–wearing population make corneal pain a particularly common clinical encounter. All agents on this page are Prescription-Only Medicines (POM) in Singapore; optometrists encountering patients who require these medications must refer to a registered medical practitioner for prescribing.^[5,6]

Patient profiles

Post-refractive surgery patients (PRK / LASEK)

Surface ablation procedures remove the corneal epithelium, causing significant pain for 48–72 hours. Topical diclofenac 0.1% or ketorolac 0.5% QID, commenced at the time of surgery, is standard of care for post-PRK pain management in Singapore refractive surgery centres and ophthalmologic practices.

Corneal abrasion — contact lens-related or occupational

Singapore's large CL-wearing population and tropical outdoor workforce experience corneal abrasions frequently. Topical NSAIDs provide effective analgesia and reduce the need for systemic analgesics; however, refer for clinical assessment before advising topical NSAID use as self-treatment is not appropriate.

Post-cataract surgery patients (CME prevention)

Cystoid macular oedema (CME) is the leading cause of unexplained visual loss post-cataract surgery. Topical NSAIDs (nepafenac, diclofenac, ketorolac) are co-prescribed with topical steroids to reduce prostaglandin-mediated CME — particularly important in diabetic patients undergoing surgery at ophthalmologic practices.

Clinical procedure patients (in-clinic anaesthesia)

Any patient undergoing applanation tonometry, Goldmann tonometry, gonioscopy, corneal foreign body removal, corneal pachymetry, or A-scan biometry requires topical anaesthesia (proxymetacaine or tetracaine) immediately before the procedure. This is instilled by the clinician — never given to the patient to take home.

Caution — contact lens wearers

Topical anaesthetics abolish corneal sensation — a contact lens wearer whose cornea is anaesthetised cannot detect the foreign body discomfort that would normally prompt lens removal. Do not allow patients to insert contact lenses after topical anaesthetic instillation until the effect has fully resolved (15–20 minutes minimum). Topical NSAIDs also reduce corneal sensitivity; advise patients on active NSAID therapy to cease contact lens wear and monitor carefully for corneal complications. Most NSAIDs are preserved with BAK — remove soft lenses before instillation and wait at least 15 minutes before reinserting.

When should they be prescribed?

Acute procedural anaesthesia (in-clinic)

Topical anaesthetics (proxymetacaine 0.5% or tetracaine 0.5–1%) are instilled immediately before applanation tonometry, gonioscopy, foreign body removal, or any contact procedure requiring corneal anaesthesia. A single dose provides adequate anaesthesia within 30 seconds. Additional drops may be instilled every 5–10 minutes for longer procedures. These agents are never dispensed to patients — repeated self-use causes progressive corneal epithelial toxicity, delayed healing, and in severe cases corneal perforation.

Post-operative pain and inflammation

Topical NSAIDs are prescribed peri-operatively for surface ablation (PRK/LASEK) and intraocular surgery (cataract). For PRK, diclofenac or ketorolac QID commenced at surgery reduces early post-operative pain effectively and does not delay re-epithelialisation when used for ≤5 days. For cataract surgery, nepafenac (TID, starting 1 day pre-op) is initiated peri-operatively and continued for 2 weeks to prevent CME — particularly in high-risk patients with diabetes, uveitis history, or fellow-eye CME.^[7,9]

Corneal abrasion analgesia and escalation

For acute corneal abrasion, topical NSAIDs provide effective analgesia without impairing epithelial healing when used short-term (24–72 hours). Diclofenac 0.1% or ketorolac 0.5% QID, combined with a bandage contact lens where appropriate, is current evidence-based management. This requires clinical assessment and prescription — optometrists should refer promptly rather than advise OTC pain management, as corneal abrasion can progress to infection, particularly in contact lens wearers where Pseudomonas aeruginosa keratitis is a serious risk.^[2]

Clinical indication	Recommended agent	Duration / Notes
Tonometry / gonioscopy / foreign body removal	Proxymetacaine 0.5% 1–2 drops — clinical use only	Single procedure dose; onset <30 sec; never dispense
Corneal abrasion — mild (non-CL related)	Diclofenac 0.1% or ketorolac 0.5% QID — refer for Rx	24–48 h; review daily; refer if no improvement
Corneal abrasion — CL-related (Pseudomonas risk)	Topical NSAID + urgent ophthalmology review	Cease CL wear; 48–72 h under ophthalmology; swab if infected
Post-PRK / LASEK pain	Diclofenac 0.1% QID or ketorolac 0.5% QID	3–5 days from surgery; under prescribing surgeon
Post-cataract inflammation / CME prevention	Nepafenac 0.1% TID	2 weeks post-op; start 1 day pre-op; under ophthalmology
Post-cataract CME — high risk (diabetes, uveitis)	Nepafenac TID + topical steroid QID	4 weeks post-op; ophthalmologist-managed

Where are they available in Singapore?

In Singapore, all topical ocular pain medications — NSAIDs and topical anaesthetics alike — are classified as Prescription-Only Medicines (POM) under the Medicines Act (Cap. 176), regulated by the Health Sciences Authority (HSA). There are no OTC or Pharmacy (P) topical analgesic eye drops available in Singapore. This means that all meaningful ocular pain management requires a prescription from a registered medical practitioner.

Scope of practice — Singapore optometrists

Under the Optometrists and Opticians Act (Cap. 213A), Singapore-registered optometrists are authorised to examine eyes, assess visual function, and prescribe optical appliances (spectacles and contact lenses). They do not have the authority to prescribe, supply, or administer therapeutic medications, including all topical NSAIDs and topical anaesthetics listed on this page. In practice, optometrists working in ophthalmologic practice settings may administer topical anaesthetics (e.g., proxymetacaine before applanation tonometry) within supervised clinical protocols under the authority of a supervising ophthalmologist — but this is within a medical framework, not independently. Any patient requiring topical NSAID therapy must be referred to a registered medical practitioner for prescription.^[5,6]

Prescription-only (POM) — topical NSAIDs: Diclofenac 0.1% (Voltaren Ophtha), ketorolac 0.5% (Acular), and nepafenac 0.1% (Nevanac) all require a valid prescription from a registered medical practitioner. These are dispensed via ophthalmologic practice pharmacies, licensed retail pharmacies, and in-house at ophthalmology clinics.
Prescription-only (POM) — topical anaesthetics: Proxymetacaine 0.5% (Alcaine) and tetracaine 0.5–1% (Minims Tetracaine) are clinical-use agents stocked and administered within eye care facilities as part of clinical procedures. They are not dispensed to patients and are not available at retail pharmacy counters.
Ophthalmologic practice formularies: Ophthalmologic practices routinely stock all listed NSAIDs and topical anaesthetics. Post-operative NSAID prescriptions are issued at discharge and filled at in-house or linked pharmacies. Refractive surgery centres prescribe diclofenac or ketorolac as standard post-PRK analgesia.
Private ophthalmology and refractive surgery clinics: Private eye clinics commonly prescribe topical NSAIDs for post-refractive surgery patients. Prescriptions are filled at in-house dispensaries or major retail pharmacies that stock ophthalmic POM products.
HSA product verification: Current registration status and supply schedule for all products can be confirmed via the HSA product registration portal (hsa.gov.sg). Always verify before referring for any specific product.^[5]

Why use topical agents over systemic analgesics?

Topical ocular NSAIDs deliver high local drug concentrations directly to the site of prostaglandin synthesis — the corneal epithelium, stroma, and anterior segment — with minimal systemic absorption, producing targeted analgesia and anti-inflammatory effects without the gastrointestinal, cardiovascular, and renal risks associated with systemic NSAID therapy. For post-surgical ocular inflammation, targeted topical delivery is pharmacologically superior to systemic dosing for anterior segment disease.

Targeted ocular delivery

Direct application to the ocular surface achieves local drug concentrations several orders of magnitude higher than systemic routes, providing effective analgesia at the site of injury without requiring systemic NSAID doses.

Minimal systemic adverse effects

Topical NSAIDs avoid the gastrointestinal mucosal toxicity, cardiovascular risk, and renal impairment associated with oral NSAIDs — relevant in elderly post-cataract surgery patients with polypharmacy and comorbidities.

CME prevention — a unique indication

Systemic NSAIDs do not reliably prevent pseudophakic CME. Topical NSAIDs, particularly nepafenac, achieve intraocular levels sufficient to inhibit prostaglandin-mediated CME formation at the macula — an effect inaccessible to topical steroids alone.

Additive benefit with topical steroids

Topical NSAIDs and corticosteroids act on different parts of the inflammatory cascade and are routinely co-prescribed post-cataract surgery. The combination provides superior anti-inflammatory control compared to either agent alone, without increasing systemic adverse effects.

Oral analgesics (paracetamol, oral NSAIDs) may be appropriate as adjuncts for severe post-PRK pain in the first 24–48 hours when topical agents alone are insufficient. In such cases, combination with topical diclofenac or ketorolac and a bandage contact lens is standard of care at major refractive surgery centres in Singapore.^[3,7]

How to use pain management eye drops — patient instructions

Instillation technique

Wash hands thoroughly before handling the bottle.
Tilt head back slightly and gently pull down the lower eyelid to form a pocket in the lower fornix.
Hold the bottle inverted and squeeze one drop into the lower fornix — avoid touching the tip to the eye, eyelashes, or eyelids to prevent contamination and reflex blinking.
Gently close the eye and apply nasolacrimal occlusion (gentle pressure at the inner corner of the eye) for 1–2 minutes to reduce systemic absorption and maximise ocular contact time.
If co-prescribed with topical steroid drops or lubricants, wait at least 5 minutes between each preparation to avoid dilution or washout of the first agent.
Recap the bottle immediately after use; store as directed. Shake suspensions (e.g., Nevanac) well before each instillation. Discard multi-dose bottles 28 days after opening unless the label states otherwise.

Contact lens guidance

Remove soft contact lenses before instilling topical NSAIDs. Most formulations are preserved with BAK, which adsorbs onto soft lens material and causes toxic keratopathy. Reinsert lenses at least 15 minutes after instillation if wearing is clinically appropriate.
During active corneal abrasion treatment, contact lens wear should be suspended for the duration of therapy. The cornea is at elevated risk of infection and further epithelial injury while healing; lens wear should only resume on clinical clearance by the prescribing practitioner.
Post-operative refractive surgery patients (PRK/LASEK) are fitted with a therapeutic bandage contact lens at the time of surgery. Topical NSAID drops are instilled over the lens by the patient as directed — this is a specific exception to the general rule and is explicitly prescribed by the surgeon.
Topical anaesthetics (proxymetacaine, tetracaine) are administered in-clinic only. Patients must not insert contact lenses until corneal sensation has fully recovered — at least 15–20 minutes after instillation.

Monitoring and red-flag referral

All NSAID users: Review corneal epithelial integrity at each visit. Discontinue immediately if a persistent epithelial defect, corneal thinning, or melting is detected — rare but potentially sight-threatening NSAID-related complications.
Corneal abrasion patients: Review within 24–48 hours. Failure to heal, increasing pain, or development of a stromal infiltrate requires urgent ophthalmology referral — these may indicate microbial keratitis, particularly in contact lens wearers where Pseudomonas aeruginosa is a significant pathogen.^[2]
Post-cataract patients: Monitor visual acuity at each post-operative visit; unexplained visual loss at 4–6 weeks should prompt OCT macula to exclude CME. Optimise NSAID compliance if CME is detected and co-manage with the operating ophthalmologist.
Red flags requiring urgent referral: Progressive corneal haziness or thinning during NSAID therapy; increasing rather than decreasing pain 48+ hours post-PRK; purulent or mucopurulent discharge suggesting infection; significant photophobia with reduced acuity; any hypopyon or anterior chamber reaction.

Common pain management eye drops in Singapore

All agents listed are, or have been, registered with HSA Singapore or are available through registered importers. Verify current product registration at hsa.gov.sg before prescribing.

Brand (Generic)	Mechanism	Dosing	Min. Age	Side Effects	Clinical Notes
Voltaren Ophtha Diclofenac sodium 0.1% POM	NSAID — selective COX inhibitor	1 drop QID; post-PRK × 3–5 days	≥18 years	Transient stinging, punctate keratitis	Post-PRK pain, corneal abrasion, CME prophylaxis; avoid in NSAID hypersensitivity
Acular Ketorolac tromethamine 0.5% POM	NSAID — non-selective COX-1 & COX-2 inhibitor	1 drop QID; post-op × 2 weeks	≥3 years	Stinging, burning, superficial keratitis	Post-cataract inflammation & allergic itch; most stinging on instillation of topical NSAIDs
Nevanac Nepafenac 0.1% POM	NSAID prodrug — converted to amfenac intraocularly	1 drop TID; start 1 day pre-op × 2 weeks post-op	≥10 years	Foreign body sensation, transient blurred vision	CME prevention post-cataract; preferred in diabetic patients; suspend if epithelial defect
Alcaine Proxymetacaine hydrochloride 0.5% POM	Ester anaesthetic — Na⁺ channel blockade	1–2 drops pre-procedure; repeat q5–10 min PRN	Adults	Transient stinging, epithelial toxicity with repeated use	CLINICAL USE ONLY — tonometry, FB removal; NEVER dispense; onset <30 sec, duration 10–15 min
Minims Tetracaine Tetracaine 0.5% / 1% POM	Ester anaesthetic — Na⁺ channel blockade; longer duration than proxymetacaine	1 drop per procedure; single-use unit	Adults	Pronounced stinging, epithelial toxicity, rare hypersensitivity	CLINICAL USE ONLY — NEVER dispense; preservative-free; onset 30–60 sec, duration 15–20 min

Legend

POMPrescription Only Medicine — Sold or supplied to the public on prescription only.

PPharmacy Medicine — Sold or supplied from any licensed retail pharmacy under pharmacist supervision.

OTCGeneral Sales List (GSL) — Sold or supplied to the public without restriction.

Dosing reflects standard adult doses unless noted. Always refer to the approved product insert for full prescribing information. BD = twice daily, TID = three times daily, QID = four times daily, PRN = as needed. Topical anaesthetics are for clinical use only and are never dispensed for patient self-administration.

References

[1] Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol. 2010;55(2):108–133. PMID: 20159228.
[2] Swamy BN, Chilov M, McClellan K, Petsoglou C. Topical non-steroidal anti-inflammatory drugs in corneal abrasions: meta-analysis of randomised trials. Clin Experiment Ophthalmol. 2007;35(4):368–374. PMID: 17539792.
[3] Tan DT, Fong A. Efficacy of neural pain control in enhancing epithelial healing after photorefractive keratectomy. J Refract Surg. 1996;12(6):755–759. PMID: 8953834.
[4] McGee HT, Fraunfelder FW. Toxicities of topical ophthalmic anesthetics. Expert Opin Drug Saf. 2007;6(6):637–640. PMID: 17967152.
[5] Republic of Singapore. Optometrists and Opticians Act 2007 (No. 16 of 2007). Singapore Statutes Online. Available at: sso.agc.gov.sg/Act/OOA2007 (accessed March 2026).
[6] George PP, Chng OSY, Siow K, et al. Is there scope for expanding the optometrist's scope of practice in Singapore? A survey of optometrists and opticians. Cont Lens Anterior Eye. 2019;42(3):258–264. PMID: 30819628.
[7] Colin J. The role of NSAIDs in the management of postoperative ophthalmic inflammation. Drugs. 2007;67(9):1291–1308. PMID: 17547471.
[8] Heier JS, Topping TM, Baumann W, Dirks MS, Chern S. Ketorolac versus prednisolone versus combination therapy in the treatment of acute pseudophakic cystoid macular edema. Ophthalmology. 2000;107(11):2034–2038. PMID: 11054337.
[9] Nardi M, Lobo C, Berdeaux G, et al. Subjective and objective assessment of diclofenac 0.1% versus ketorolac 0.5% in treating postcataract surgery inflammation. Eur J Ophthalmol. 2007;17(3):341–347. PMID: 17534812.
[10] Health Sciences Authority Singapore. Register of Therapeutic Products. Available at: hsa.gov.sg (accessed March 2026).

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