Acute bacterial infection of the external eye, including cute bacterial conjunctivitis, corneal ulceration, blepharitis, dacryocystitis, and discharging sockets are caused by the pathogens Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenza. Bacterial infections are generally treated topically with eye drops and eye ointments. Systemic administration is sometimes appropriate in blepharitis.

Intra-occular infection, a variety of routes (intra corneal, intra vitreal and systemic) may be used. Chloramphenicol has a broad spectrum of activity and is the drug of choice for superficial eye infections. Chloramphenicol eye drops are well tolerated and the recommendation that chloramphenicol eye drops should be avoided because of an increased risk of aplastic anaemia is not well founded.

Gentamicin is the antibiotic of choice for infections due to Pseudomonas aeruginosa and Coliform bacilli.

Chloramphenicol
Eye ointment, 1 %, 5 %
Solution (eye drop), 0.4 %, 0.5 %, 1 %, 5 %

Indications: - topical treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by susceptible organisms.

Contraindications - previous allergy or toxic reaction to chloramphenicol

Side effects - hypersensitivity (burning, itching, redness, skin rash, swelling or other signs of irritation not present before therapy)

Dose and Administration

Adult & child: Ointment - topical, to the conjunctiva, a thin strip (approximately 1cm) of ointment every three hours or more frequently; Solution (eye drops)- topical, to the conjunctiva, 1 drop every one to four hours.

Storage - at room temperature in a tight container, protect from freezing.

Erythromycin
Eye ointment, 0.5 %

Indications: - topical prophylaxis of neonatal conjunctivitis caused by Chlamydia trachomatis. It is also used in the topical treatment of superficial ocular infections of the conjunctiva and/or cornea caused by susceptible organisms.

Cautions: - intolerance to erythromycin.

Side effects: - eye irritation not present before therapy.

Dose and Administration -

Adult, Child: ocular infection - topical, to the conjunctiva, a thin strip (approximately 1cm) of ointment up to six times a day, depending on the severity of the infection.

Neonatal conjunctivitis/Ophthalmia neonatorum - topical, to each conjunctiva, a thin strip (approximately 0.5 to 1 cm) of ointment as a single dose following cesarean or vaginal delivery.

Storage: - at room temperature. Protect from freezing.

Gentamicin
Solution (eye drop), 0.3 %

Indications: - blepharitis; bacterial conjunctivitis; systemic infections.

Cautions: - prolonged use may lead to skin sensitization and emergence of resistant organisms including fungi; discontinue if purulent discharge; inflammation or exacerbation of pain.

Side effects: burning, stinging, itching, dermatitis.

Contraindications: - hypersensitivity to aminoglycoside group of antibiotics.

Dose and Administration

Mild to moderate infection, by instillation into the eye, Adult and Child, 1 drop every hours, reducing frequency as infection is controlled, then continue for 48 hours after healing is complete.

Severe infection, by installation in to the eye, Adult and child, 1 drop every hour, reducing frequency as infection is controlled, then continue for 48 hours after healing is complete.

Neomycin Sulphate
Eye ointment 0.5 %, 2 %

Indications: - treatment of superficial ocular infections, involving the conjunctiva and, or cornea, caused by susceptible organisms. It is also used in the treatment of bacterial blepharitis, blepharoconjunctivitis, bacterial conjunctivitis, bacterial keratitis and bacterial keratoconjuctivitis.

Cautions: - sensitive to neomycin.

Side effects: - hypersensitivity (itching, rash, redness, swelling, or other sign of irritation not present before therapy, burning or stinging, blurred vision).

Dose and Administration: -

Adult, child: topical to the conjunctiva, a thin strip (approximately 1cm) of ointment every eight to twenty-four hours.

Storage - at room temperature, protect from freezing

Oxytetracycline Hydrochloride
Eye ointment, 0.5

Indications: - oxyteracycline (in combination with polymyxin B sulphate) is used topically in the treatment of superficial infections of the eye caused by susceptible bacteria.

Cautions: - sensitive to tetracyclines.

Side effect - burning, stinging, increased lachrymation, foreign body sensation.

Dose and Administration

Usual Adult dose - topical, in the lower conjunctival sac of the infected eye, a thin amount of ophthalmic ointment every 2-12 hours daily.

Storage: - at room temperature in a collapsible ophthalmic ointment tube, protect from freezing.

Silver Nitrate
Solution (eye drop), 1 %

Indications: - prophylaxis of neonatal conjunctivitis (Ophthalmia neonatrum) due to Neisseria gonorrhoea, if tetracycline not available.

Cautions: - avoid use of old, concentrated drugs; wipe excess drops from skin near the eye to prevent staining.

Side effects: - skin and mucous membrane irritation, mild conjunctivitis; repeated use may cause skin discoloration, corneal cauterization and blindness.

Dose and Administration

Prophylaxis of neonatal conjunctivitis, by instillation into the eye, Newborn at birth after cleansing eyes with sterile gauze, 2 drops into each eye.

Tetracycline
Eye ointment, 1 %
Solution (eye drop), 1 %

Indications: - for the treatment of superficial bacterial infections of the eye (Purulent conjunctivitis), trachoma, and for the prophylaxis of gonococcal and nongonococcal ophthalmia neonatorum.

Dose and Administration: - Topical, to the conjunctiva.

Purulent Conjunctivitis - Adults and Children: Apply, a thin strip (approximately 1cm) of ointment onto the infected eye every 6 hours daily for 5 days.

Trachoma - Adults and Children: Apply a thin strip of ointment onto each eye twice daily for a minimum of 6 weeks.

Prophylaxis of gonococcal and nongonococcal ophthalmia neonatorum - Apply, a thin strip of ointment onto each of neonates shortly (no later than1 hour) after delivery.

Storage: - at room temperature.