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Post-marketing experience with ophthalmic NSAIDs, including ketorolac, suggests that patients with complicated ocular surgery, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular disease affecting the ocular surface (e.g., xerophthalmia, dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time may be at increased risk for corneal adverse events (corneal thinning, corneal erosion, corneal ulceration, corneal perforation) that may become sight-threatening

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Not only that, but also high freshwater endemism heightens the risk of extinction of species under these stressors (Nuwanka and Gunathilaka, 2023