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

Nepafenac eye drops (Nevanac 0.1% or Ilevro 0.3%) are used after cataract surgery to manage pain and inflammation. Like any medication, they can cause side effects. Most are mild and expected during the post-surgical recovery period — but some require immediate attention. Here's how to tell the difference.

Common Side Effects (Usually Mild and Expected)

The most frequently reported side effects of Nepafenac are related to the eye surface or are systemic responses common with NSAIDs. Keep in mind that some of these may be hard to distinguish from the normal effects of cataract surgery itself.

• Foreign body sensation: Feeling like something is in your eye — very common after eye surgery and with topical eye drops
• Lid margin crusting: Crusty buildup on the eyelids, especially after sleeping — gently clean with a warm washcloth
• Ocular discomfort or irritation: Mild stinging or burning upon instillation
• Ocular hyperemia (redness): Red eye is common after surgery and may be mildly exacerbated by topical NSAIDs
• Decreased visual acuity: Temporary blurriness after using drops — allow several minutes before driving or operating machinery
• Posterior capsule opacification (secondary cataract): Cloudiness that can develop after cataract surgery — may be related to surgery itself rather than the medication
• Headache, nausea, runny nose: Occasional systemic effects from the small amount of medication absorbed; generally mild

Serious Side Effects (Call Your Doctor Promptly)

A small subset of patients can experience more serious complications. These are less common but require prompt evaluation:

• Keratitis (corneal inflammation): Nepafenac can cause inflammation of the cornea, which may affect vision. Risk is higher with longer-than-prescribed use and in patients with diabetes, rheumatoid arthritis, or prior corneal disease.
• Corneal thinning or ulceration: Rare but serious. Do not use Nepafenac beyond the prescribed period (14 days post-surgery, unless directed otherwise by your surgeon).
• Increased ocular bleeding (hyphema): NSAIDs can increase bleeding tendency in eye tissues during and around surgery. Patients on blood thinners or with bleeding disorders should discuss this with their surgeon before surgery.
• Delayed wound healing: Topical NSAIDs can slow healing, especially when combined with topical corticosteroids. Attend all follow-up appointments so your doctor can monitor healing progress.
• Potential vision loss: In severe cases of corneal complications, vision may be affected. This is why it's critical to use Nepafenac exactly as prescribed and report any concerning symptoms immediately.

Warning Signs — Call Your Eye Doctor Immediately If You Have:

• Sudden or worsening vision loss
• Significant eye pain (beyond mild discomfort after surgery)
• Visible blood in the white part of the eye (hyphema)
• Increasing sensitivity to light (photophobia)
• Eye discharge, severe redness, or swelling (possible signs of infection)
• Seeing specks, floaters, or flashing lights not previously present

Who Is at Higher Risk for Side Effects?

Certain patients have a higher risk of corneal complications with topical NSAIDs. Make sure your surgeon and pharmacist know if you have:

• Diabetes mellitus (elevated risk for punctate keratitis with prolonged use)
• Rheumatoid arthritis
• Dry eye syndrome or any pre-existing corneal disease
• History of multiple eye surgeries within a short time period
• Bleeding disorders or use of blood-thinning medications

Important Safety Tips

• Never use Nepafenac for longer than prescribed without your doctor's guidance
• Do not wear contact lenses while using Nepafenac — the preservative benzalkonium chloride can damage soft contact lenses
• Shake the bottle well before each use
• Do not share your bottle between eyes if your surgeon recommends separate bottles for each eye
• Avoid touching the dropper tip to your eye or any surface to prevent contamination

The Bottom Line

Most patients using Nepafenac for the prescribed two-week post-surgical course tolerate it well. Mild eye irritation and temporary blurriness are expected. Serious side effects are rare but can be serious — know what to watch for and don't hesitate to call your eye doctor with any concerns. Also read our guide to Nepafenac drug interactions to make sure you're not taking anything that increases your risk.