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Ophthalmic Infections

 

Eye Condition Possible therapeutic alternatives
Blepharitis (eyelid) Common pathogens (Topical ointment ) bacitracin or erythromycin applied 2 to 4 times per day. Clean eyelid daily.
Conjunctivitis:  Common pathogens
Erythromycin (Ilotycin): ½" of ointment q3-4h or bid-qid. [ointment 0.5%]  or   
Gentamycin (Garamycin): 1-2 drops every 2-4 hours or ½" ointment bid-tid. [0.3% oint/soln] or  
Neosporin ( neomycin, bacitracin, polymyxin):  1-2 drops q1-6h or ½" oint q3-4h.  or 
Polytrim ( 1 mg trimethoprim/ polymyxin B sulfate 10,000 units): mild to moderate infections, instill 1 drop q3h (maximum of 6 doses per day) x 7 to 10 days.
Sulfacetamide (Bleph-10, Sulamyd): 
Instill 1-2 drops every 2-3 hours initially. Dosages may be tapered by increasing the time interval between doses as the condition responds (e.g. qid). Usual duration: 7-1 0 days. or ½" ointment q3-8h.
Tobramycin (Tobrex): 
Solution: mild to moderate 1-2 drops q4h.  
Severe infections
, instill 2 drops into the eye(s) hourly until improvement, following which treatment should be reduced prior to discontinuation.  
TobraDex (Tobra + dexamethasone): 1-2 drops every 2 to 6 hours or ½" ointment 2 to 4 times daily.
Ciprofloxacin (Ciloxan)
Corneal ulcers:
2 drops q15 minutes x six hours, then 2 drops every 30 minutes for the remainder of the first day.  Day #2: instill 2 drops in the affected eye hourly. Day 3rd -14th: , place 2 drops in the affected eye q4h.  Treatment may be continued after 14 days if corneal re-epithelialization has not occurred. 

Conjunctivitis: 1-2 drops every 2 hours while awake x 2 days, then 1-2 drops every 4 hours while awake x five days. Ointment: Apply a ½" ribbon into the conjunctival sac  tid x 2 days, then apply a ½" ribbon bid x 5 days.

Ofloxacin (Ocuflox): 
bacterial conjunctivitis
: 1-2 drops q2-4 hours x 2 days,  then  Instill 1-2 drops four times daily x 5 days. 

Corneal ulcers/keratitis: Instill 1-2 drops every 30 minutes, while awake. Awaken at approximately 4 and 6 hours after retiring and instill 1-2 drops x 2 days. Then Instill 1-2 drops hourly, while awake x 5 days. Then Instill 1-2 drops, four times daily x 3 days.

Keratitis (Cornea) H.Simpex   Trifluridine (Viroptic):  1 drop q1h (9 times per day) for up to 21 days.
Keratitis 
(varicella-zoster)
  Famciclovir 500mg po tid or Valacyclovir 1 gram po tid or  Acyclovir 800mg po 5 times per day.
Vision- threatening bacterial infection

>1.5 mm diameter ulcer, other.

 

Fortified ophthalmic drops
(Topical)

Usual regimen: Fortified tobramycin or gentamicin (14-15 mg/ml) q1h alternating with  [ fortified Ancef (50 mg/ml)  or Vancomycin (25-50mg/ml) q1h. ]

Fortified Ancef (Cefazolin) (50 mg/ml):
Reconstitute 1 gram cefazolin powder with 5ml (200mg/ml) sterile water (without preservative) or reconstitute 500mg vial with 2.5 ml. Then you may use any of the following dilutions:

Add 1 ml to 3 ml artificial tears. Final concentration: 50 mg/ml. Refrigerate. Reported stability: 4-7 days.

Add 2 ml to 6 ml of artificial tears. Final concentration: 50 mg/ml. Refrigerate. Reported stability: 4-7 days.

Add 4 ml to 12 ml artificial tears. Final concentration: 50 mg/ml. Refrigerate. Reported stability: 4-7 days.

(Side note: when adding the cefazolin to the artificial tears, aseptically remove the dropper head in a laminar flow hood. Do not attempt to use a needle through the dropper head, which may alter the intended drop size).

Alternative: Dilute 500mg vial of cefazolin powder with 10 ml sterile water. Label: Final concentration: 50 mg/ml. Refrigerate. Stability: 7 days.

Fortified Gentamicin or Tobramycin: (Usual concentration: 14 mg/ml): 
Start with the commercially available solution: Gentamicin 0.3% 5ml (15 mg/5 ml) ophthalmic solution or Tobramycin 0.3% 5ml (15 mg/5 ml) ophthalmic solution (. Add 2 ml of gentamicin or tobramycin injection (80mg/2ml) to the respective ophthalmic solution. Label:  
Concentration: 14 mg/ml. 
REFRIGERATE, 
Expires: 7 days.

(Side note: when adding the tobramycin or gentamicin to the respective container, aseptically remove the dropper head in a laminar flow hood. Do not attempt to use a needle through the dropper head, which may alter the intended drop size).

Vancomycin ophthalmic drops
 (Usual concentration: 25-50 mg/ml). Some studies have found the 25 mg/mL concentration to have similar efficacy compared to the 50mg/ml concentration and with better patient tolerance.

Preparation (50 mg/ml): Reconstitute 500mg Vancomycin powder with 10 ml sterile water (without preservative). Alternatively, use 10ml of artificial tears. Label
Concentration: 50 mg/ml, 
REFRIGERATE; 
Expires: 4 days.

Dosing: (Adult Dose) 1 drop hourly for first 24 hours, then taper gradually according to clinical improvement

 

Ocular Decongestants/ Anti-Allergy.

Cromolyn sodium (Crolom): vernal conjunctivitis, keratitis, and keratoconjunctivitis 1-2 drops in each eye, 4-6 times daily, at regular intervals.
Ketotifen Fumarate Ophthalmic Solution 0.025% (Zaditen) Allergic conjunctivitis: 1 drop bid, (q8-12 hours). (non-competitive histamine antagonist and mast cell stabilizer)
Levocabastine (Livostin): Allergic conjunctivitis 1 drop in affected eye BID-QID. [susp: 0.05%] (Antihistamine)
Lodoxamide tromethamine (Alomide): Vernal keratoconjunctivitis. Dosing: 1-2 drops four times daily. [soln: 0.1%] Cromolyn-like action.
Naphazoline (Naphcon, Vasocon): Ocular decongestant. Dosing: 1 drop every 3 to 4 hours as needed up to 4 times daily.
Vasocon-A antazoline phosphate (0.5%), naphazoline hydrochloride (0.05%) Antihistamine/decongestant: Dosing: 1-2 drops 2 to 4 times daily as needed.
Olopatadine (Patanol): Allergic conjunctivitis: 1-2 drops twice daily. [0.1% soln] (selective H1-receptor antagonist and mast-cell release inhibitor)
Pemirolast (Alamast): Allergic conjunctivitis: 1-2 drops qid.

 

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Conjunctivitis