A Textbook of Clinical Pharmacology and Therapeutics

DRUGS USED TO TREAT EYE INFECTIONS

Several antimicrobial agents are formulated for ophthalmic
use (see Tables 52.3 and 52.4). Appropriate selection of an anti-
bacterial agent and the route of administration depend on the
clinical findings and culture and sensitivity results. Acute bac-
terial conjunctivitis is usually due to Staphylococcus aureusor
Streptococcus.Chloramphenicol,gentamicin,fusidic acidor
one of the fluoroquinolones (e.g. ciprofloxacin,ofloxacin), all
of which are available as eye drops, may be appropriate.

DRUGS USED TO TREAT INFLAMMATORY

DISORDERS IN THE EYE

POST SURGERY

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to
reduce post-operative inflammation. Several such ophthalmic
preparations are available, including diclofenac,flurbiprofen
andketorolac.

OTHER ANTI-INFLAMMATORY OCULAR DRUG

THERAPIES

GLUCOCORTICOSTEROIDS

Topical ocular glucocorticosteroids should only be used under

specialist supervision to treat uveitis and scleritis, and some-

times in the post-operative setting. They should never be used

to treat the undiagnosed ‘red-eye’ which could be due to a

herpes infection, which is aggravated by glucocorticosteroids

and may progress to loss of the eye. Furthermore, topical

steroids produce or exacerbate glaucoma in genetically pre-

disposed individuals (Chapter 14). Thinning of the cornea or

perforation of the sclera may occur in susceptible patients.

A number of preparations are available (e.g. hydrocortisone

orbetametasone– both available as drops or ointment).

ANTIHISTAMINES AND MAST CELL STABILIZERS

These agents are used to treat allergic or seasonal conjunctivitis.

Topical antihistamines for ophthalmic use include antazoline

andazelastine. Ocular irritation, oedema of the eyelids or

blurred vision can occur, as can systemic effects (e.g. drowsiness).

DRUGSUSED TOTREATINFLAMMATORYDISORDERS IN THEEYE 427

Table 52.3:Antibacterial agents used to treat conjunctivitis and blepharitis

Drug class or drug Indication and use Toxicity

Chloramphenicol

Fluoroquinolones (e.g. norfloxacin,

ofloxacin, ciprofloxacin) Broad-spectrum antibacterials Local irritation and hypersensitivity

Framycetin sulphate reactions

Aminoglycosides (e.g. gentamicin

sulphate, neomycin sulphate)

Ciprofloxacin hydrochloride Corneal ulceration Causes local burning and itching; best avoided in

children

Chlortetracycline Chlamydial infections Local irritation and hypersensitivity reactions

Gentamicin sulphate Pseudomonas aeruginosainfections Local irritation and hypersensitivity reactions

Tobramycin

Sodium fusidate Staphylococcal infections Hypersensitivity reactions

Table 52.4:Antiviral agents for eye infections

Drug Route Indication for use Toxicity

Idoxuridine Topical Herpes simplex keratitis Punctate keratopathy and hypersensitivity

Aciclovir Topical (3%) Herpes simplex keratitis

Oral/intravenous Herpes zoster ophthalmicus

Foscarnet Intravenous/intravitreal Cytomegalovirus retinitis

Ganciclovir Intravenous/intravitreal Cytomegalovirus retinitis

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