Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Corneoscleral Laceration Medication

  • Author: Guruswami Giri, MD, FRCS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jul 05, 2016
 

Medication Summary

Systemic antibiotics are routinely used for prophylaxis against infection. Endophthalmitis is uncommon but has a poor prognosis in the setting of ocular trauma. In one study, delayed repair, ruptured lens capsule, and dirty wound were each independently associated with the development of posttraumatic endophthalmitis. Antibiotics should cover both gram-positive and gram-negative organisms, including Bacillus, which is the most common cause of posttraumatic endophthalmitis.[6]

No controlled studies are available that show any benefits of systemic antibiotics.

Next

Antibiotics

Class Summary

Therapy must cover all likely pathogens in the context of this clinical setting. Any of the fluoroquinolones may be used safely as ophthalmic drops.

Vancomycin (Vancoled, Vancocin, Lyphocin)

 

Provides excellent gram-positive coverage, including Bacillus. To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dose. Use creatinine clearance to adjust dose in patients with renal impairment.

Ceftazidime (Tazidime, Fortaz, Ceptaz, Tazicef)

 

Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin binding proteins.

Gatifloxacin ophthalmic (Zymar)

 

Fourth-generation fluoroquinolone ophthalmic indicated for bacterial conjunctivitis. Elicits a dual mechanism of action by possessing an 8-methoxy group; thereby, inhibiting the enzymes DNA-gyrase and topoisomerase IV. DNA gyrase is involved in bacterial DNA replication, transcription, and repair. Topoisomerase IV is essential in chromosomal DNA partitioning during bacterial cell division.

Moxifloxacin ophthalmic (Vigamox)

 

Indicated to treat bacterial conjunctivitis. Elicits antimicrobial effects. Inhibits topoisomerase II (DNA gyrase) and IV enzymes. DNA gyrase is essential in bacterial DNA replication, transcription and repair. Topoisomerase IV plays a key role in chromosomal DNA portioning during bacterial cell division.

Previous
Next

Carbonic anhydrase inhibitors

Class Summary

These agents are used to treat elevation of intraocular pressure associated with ocular injuries or inflammation. By slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport, it may inhibit the enzyme carbonic anhydrase in the ciliary processes of the eye. This effect decreases aqueous humor secretion, reducing intraocular pressure.

Acetazolamide (Diamox)

 

Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces intraocular pressure. Used for adjunctive treatment of chronic simple (open-angle) glaucoma and secondary glaucoma and preoperatively in acute angle-closure glaucoma when delay of surgery desired to lower intraocular pressure.

Previous
Next

Anticholinergic agents

Class Summary

These are thought to work centrally by suppressing conduction in the vestibular cerebellar pathways. They may have an inhibitory effect on the parasympathetic nervous system.

Homatropine (AK-Homatropine, Isopto Homatropine)

 

Blocks responses of sphincter muscle of iris and muscle of ciliary body to cholinergic stimulation, producing pupillary dilation (mydriasis) and paralysis of accommodation (cycloplegia). Induces mydriasis in 10-30 min and cycloplegia in 30-90 min. These effects last up to 48 h.

Previous
Next

Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli. Corticosteroids may be used to reduce postoperative inflammation.

Dexamethasone ophthalmic (Ocu-Dex, AK-Dex, Alba-Dex, Baldex, Decadron)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Previous
 
 
Contributor Information and Disclosures
Author

Guruswami Giri, MD, FRCS Vitreo-Retinal Surgeon, Sacramento, CA

Guruswami Giri, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology, Royal College of Surgeons of Edinburgh, Royal College of Ophthalmologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Stephen D Plager, MD 

Stephen D Plager, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, California Medical Association

Disclosure: Nothing to disclose.

References
  1. McGwin G Jr, Hall TA, Xie A, et al. Trends in eye injury in the United States, 1992-2001. Invest Ophthalmol Vis Sci. 2006 Feb. 47(2):521-7. [Medline].

  2. McGwin G Jr, Xie A, Owsley C. Rate of eye injury in the United States. Arch Ophthalmol. 2005 Jul. 123(7):970-6. [Medline].

  3. Ryan SJ, Allen AW. Pars plana vitrectomy in ocular trauma. Am J Ophthalmol. 1979 Sep. 88(3 Pt 1):483-91. [Medline].

  4. Brinton GS, Topping TM, Hyndiuk RA, et al. Posttraumatic endophthalmitis. Arch Ophthalmol. 1984 Apr. 102(4):547-50. [Medline].

  5. Essex RW, Yi Q, Charles PG, et al. Post-traumatic endophthalmitis. Ophthalmology. 2004 Nov. 111(11):2015-22. [Medline].

  6. Schemmer GB, Driebe WT Jr. Posttraumatic Bacillus cereus endophthalmitis. Arch Ophthalmol. 1987 Mar. 105(3):342-4. [Medline].

  7. Barr CC. Prognostic factors in corneoscleral lacerations. Arch Ophthalmol. 1983 Jun. 101(6):919-24. [Medline].

  8. Albert DM, Jakobiec FA. Principles and Practice of Ophthalmology. WB Saunders Co; 2000. Vol 6: 5179-5217.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.