Ophthalmology/Topical anti-infectives, steroids & lubricants

Eye anti-infectives, steroids & lubricants

also: chloramphenicol · topical aciclovir · prednisolone eye drops · artificial tears

Overview

The everyday eye drops — conjunctivitis antibiotics, HSV keratitis antivirals, anti-inflammatory steroids (with their cautions), and dry-eye lubricants.

Mechanism

Topical antibiotic (chloramphenicol) for bacterial conjunctivitis; topical antiviral (ganciclovir gel / aciclovir) for dendritic HSV keratitis; topical corticosteroid suppresses ocular inflammation; ocular lubricants replace the tear film.

Indications

Bacterial conjunctivitis (chloramphenicol)
Herpes simplex keratitis (topical antiviral)
Anterior uveitis / inflammation (topical steroid — specialist)
Dry eye (lubricants)

The agents

Chloramphenicol drops/ointmentantibiotic

Bacterial conjunctivitis first-line; contact-lens wearers → cover Pseudomonas (quinolone).

Ganciclovir gel / aciclovirantiviral

Dendritic HSV keratitis — do NOT give a topical steroid alone (worsens HSV).

Prednisolone / dexamethasone dropscorticosteroid

specialist

Uveitis/post-op; cause cataract + steroid-induced glaucoma + worsen HSV — specialist use.

Artificial tears (hypromellose, carbomer)lubricant

Dry eye.

Adverse effects

Topical steroids → cataract, raised IOP/glaucoma, worsen herpetic keratitisserious

Never give steroid drops for an undiagnosed red eye.

Chloramphenicol: transient stinging; (theoretical aplastic anaemia)common

Cautions & contraindications

Topical steroid in undiagnosed red eye / HSV keratitisall

Can perforate a dendritic ulcer / mask infection.

Interactions

Monitoring & kinetics

Steroid drops: IOP monitoring; resolution of infection

Topical. Red flags (pain, photophobia, ↓acuity) → same-day ophthalmology, not just drops.

Source: NICE CKS — Conjunctivitis / red eye · BNF — Eye - anti-infectives/corticosteroids