Clinical Pharmacology and Therapeutics

DRUGS USED TO TREAT INFLAMMATORY DISORDERS IN THE EYE 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 aeruginosa infections 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
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 antibacterial
agent and the route of administration depend on the
clinical findings and culture and sensitivity results. Acute bacterial
conjunctivitis is usually due to Staphylococcus aureus or
Streptococcus. Chloramphenicol, gentamicin, fusidic acid or
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
and ketorolac.
OTHER ANTI-INFLAMMATORY OCULAR DRUG
THERAPIES
GLUCOCORTICOSTEROIDS
Topical ocular glucocorticosteroids should only be used under
specialist supervision to treat uveitis and scleritis, and sometimes
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 predisposed
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
or betametasone – 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
and azelastine. Ocular irritation, oedema of the eyelids or
blurred vision can occur, as can systemic effects (e.g. drowsiness).