Ilevro Side Effects: What to Expect and When to Call Your Doctor

Ilevro (nepafenac 0.3% ophthalmic suspension) is generally well-tolerated, but like all medications, it can cause side effects. Understanding which reactions are normal and which require immediate medical attention will help you use Ilevro safely throughout your cataract surgery recovery.

Common Side Effects of Ilevro (5–10% of Patients)

The most frequently reported side effects after cataract surgery while using Ilevro, occurring in approximately 5-10% of patients, include:

Capsular opacity: Cloudiness behind the lens implant (posterior capsule opacification) — common after cataract surgery regardless of which NSAID is used

Decreased visual acuity: Some blurring of vision during the recovery period, typically temporary

Foreign body sensation: The feeling of something in the eye, common with topical eye medications

Increased intraocular pressure (IOP): Temporary elevation; your surgeon monitors this at follow-up visits

Sticky sensation: Eye may feel sticky, especially in the morning — related to the suspension formulation

Less Common Side Effects (1–5% of Patients)

Additional side effects reported in 1-5% of Ilevro users include:

Conjunctival edema (redness and swelling of the white of the eye)

Corneal edema (swelling of the clear front of the eye)

Dry eye symptoms

Lid margin crusting

Ocular discomfort, pain, or itching (pruritus)

Photophobia (light sensitivity)

Tearing (watery eyes)

Headache, sinus congestion, nausea — systemic effects (rare with topical use)

Serious Side Effects: Call Your Doctor Immediately

While rare, Ilevro can cause serious eye problems that require immediate medical attention. Stop using Ilevro and contact your ophthalmologist right away if you experience:

Significant worsening of vision — particularly sudden or severe vision changes

Severe eye pain — distinct from mild discomfort or foreign body sensation

Corneal symptoms — persistent blurring, hazy cornea, or sensation of something stuck on the eye surface that doesn't resolve. Topical NSAIDs including Ilevro can in rare cases cause keratitis, corneal thinning, erosion, ulceration, or perforation, which are sight-threatening.

Signs of eye infection — increased redness, significant discharge, swollen eyelids, fever. Contaminated eye drop bottles can cause serious infections.

Blood in the eye (hyphema) — Ilevro can increase bleeding time; report any new blood spots immediately

Signs of allergic reaction — severe itching, hives, swelling of face, difficulty breathing

Who Is at Higher Risk for Side Effects?

Certain patients face higher risk of corneal side effects from topical NSAIDs including Ilevro:

Patients with diabetes (impaired healing)

Dry eye syndrome

Rheumatoid arthritis

History of multiple eye surgeries in a short period

Corneal denervation or corneal epithelial defects

Using Ilevro more than 1 day before surgery or more than 14 days after surgery

How to Use Ilevro to Minimize Side Effects

Shake well before each use — Ilevro is a suspension; contents settle if not shaken

Never touch the dropper tip to your eye or any surface — this prevents contamination and eye infection risk

Do not wear contact lenses while using Ilevro — the benzalkonium chloride preservative can damage soft contact lenses and your ophthalmologist will advise you on when it's safe to resume lens wear

Use only for the prescribed duration — using Ilevro longer than 14 days post-surgery increases the risk of corneal side effects

Don't share your bottle — don't use the same bottle for both eyes if having bilateral cataract surgery (use a fresh bottle for the second eye)

Also see our related guide on Ilevro drug interactions for information on medications that may increase side effect risk.