Corneoscleral Laceration Medication

Updated: Nov 19, 2018
  • Author: Guruswami Giri, MD, FRCS; Chief Editor: Hampton Roy, Sr, MD  more...
  • Print

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. [10]

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


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.


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.



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.