Most acute superficial eye infections can be treated topically. Blepharitis and conjunctivitis are often caused by staphylococci; keratitis and endophthalmitis may be bacterial, viral, or fungal. Bacterial blepharitis is treated by application of an antibacterial eye ointment to the conjunctival sac or to the lid margins. Systemic treatment may occasionally be required and is usually undertaken after culturing organisms from the lid margin and determining their antimicrobial sensitivity; antibiotics such as the tetracyclines given for 3 months or longer may be appropriate. Most cases of acute bacterial conjunctivitis are self-limiting; where treatment is appropriate, antibacterial eye drops or an eye ointment are used. A poor response might indicate viral or allergic conjunctivitis. Gonococcal conjunctivitis is treated with systemic and topical antibacterials.
Corneal ulcer and keratitis require specialist treatment and may call for hospital admission for intensive therapy.
Antibacterials
Bacterial infections are generally treated topically with eye drops and eye ointments. Systemic administration is sometimes appropriate in blepharitis. Many antibacterial preparations also incorporate a corticosteroid but such mixtures should not be used unless a patient is under close specialist supervision. In particular they should not be prescribed for undiagnosed ‘red eye’ which is sometimes caused by the herpes simplex virus and may be difficult to diagnose.
CHLORAMPHENICOL:
Indications: Bacterial conjunctivitis.
Contraindications: Aplastic anaemia
Dose and Administration: Two drops or 1 application of ointment three hourly or more frequently if required. Continue for 48 hours after clinical cure.
CIPROFLOXACIN:
Indications: Adults, newborn infants (0-27 days), infants and toddlers (28 days to 23 months), children (2-11 years) and adolescents (12 – 16 years) CILOXAN is indicated for the treatment of corneal ulcers and superficial infections of the eye and adnexa caused by susceptible strains of bacteria.
Contraindications: Hypersensitivity to the active substance or to any of the recipients. Hypersensitivity to quinolones.
Dose and Administration: Corneal Ulcers: On the first day, instil 2 drops into the affected eye every 15 minutes for the first six hours and then 2 drops into the affected eye every 30 minutes for the remainder of the day. On the second day, instil 2 drops in the affected eye hourly. On the third through the fourteenth day, place two drops in the affected eye every 4 hours. If the patient needs to be treated longer than 14 days, the dosing regimen is at the discretion of the attending physician. Superficial Ocular Infection: The usual dose is one or two drops in the affected eye(s) four times a day. In severe infections, the dosage for the first two days may be one or two drops every two hours during waking hours. For either indication a maximum duration of therapy of 21 days is recommended .
FUSIDIC ACID:
Indications: topical treatment of bacterial conjunctivitis where the organism is known to be sensitive to the antibiotic.
Contraindications: Hypersensitivity to any of its components.
Dose and Administration: For all ages: One Fucithalmic drop to be instilled into the eye twice daily. Treatment should be continued for at least 48 hours after the eye returns to normal.
GENTAMICIN:
Indications: Bacterial Blepharitis, Bacterial Conjunctivitis, Bacterial Keratitis,
Blepharoconjunctivitis, Dacryocystitis, and Meibomianitis.
Contraindications: Hypersensitivity to any of its components.
Dose and Administration: instill 2 drops into affected eye(s) by ophthalmic
route every 4 hours.
OFLOXACIN:
Indications: topical treatment of external ocular infections (such as conjunctivitis and keratoconjunctivitis) in adults and children caused by ofloxacin sensitive organisms.
Contraindications: contra-indicated in patients sensitive to ofloxacin or any of its other components.
Dose and Administration: For all ages: one to two drops in the affected eye(s) every two to four hours for the first two days and then four times daily. The length of treatment should not exceed ten days.
TETRACYCLINE:
Indications: treatment of acute and chronic conjunctivitis, acute and chronic blepharitis, blepharoconjunctivitis and corneal ulcers also useful for preventing infections in patients undergoing ophthalmic surgery.
Contraindications: contra-indicated in patients sensitive to tetracycline or any of its other components.
Dose and Administration: 1 application of the ointment should be applied into the conjunctival sac every 2 hours. The treatment should be continued for 2-3 days after disappear of symptoms.
LOMEFLOXACIN:
Indications: Bacterial conjuctivitis due to susceptible organisms.
Contraindications: Hypersensitivity to quinolones, lomefloxacin, or any component of this medication.
Dose and Administration: Adults and children (above 1 year of age): At the beginning of therapy on Day 1 instil 5 drops into the conjuctival sac within 20 minutes. Thereafter, until Day 7-9 instil 1 drop 3 times daily into the conjuctival sac.
MOXIFLOXACIN:
Indications: indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms.
Contraindications: contraindicated in patients with a history of hypersensitivity to moxifloxacin, to other quinolones, or to any of the components in this medication.
Dose and Administration: Instill one drop in the affected eye 3 times a day for 7 days.
TOBRAMYCIN:
Indications: Treatment of external infections of the eye and its adnexa caused by susceptible bacteria. Appropriate monitoring of bacterial response to topical antibiotic therapy should accompany the use of Tobramycin.
Contraindications: Contraindicated in patients with known hypersensitivity to tobramycin or any other ingredients in this product.
Dose and Administration: EYE DROPS: In mild to moderate disease, instil one or two drops into the affected eye(s) every four hours. In severe infections, instil two drops into the eye(s) hourly until improvement; following which treatment should be reduced prior to discontinuation. The usual duration of treatment is 7 to 10 days. EYE OINTMENT: apply a 1 – 1.5 cm ribbon into the affected eye(s) two or three times per day. The usual duration of treatment is 7 to 10 days.
Antivirals
ACICLOVIR (Acyclovir):
Indications: Treatment of herpes simplex keratitis.
Contraindications: contra-indicated in patients with a known hypersensitivity to aciclovir or valaciclovir.
Dose and Administration: Adults: 1cm ribbon of ointment should be placed inside the lower conjunctival sac five times a day at approximately four hourly intervals, omitting the night time application. Treatment should continue for at least 3 days after healing is complete.
