Medication Summary
An uncomplicated case in which the foreign body is removed can be treated with standard antibiotics. If a large epithelial defect is present, an antibiotic ointment is placed prior to the use of a patch. Complicated cases should be seen by an ophthalmologist immediately and prior to any therapy. For example, if an infiltrate is present, the ophthalmologist may want to scrape and plate the lesion before any antibiotic is instilled in the eye.
Antibiotics
Class Summary
Prevent infection of an open corneal abrasion.
Trimethoprim/polymyxin B ophthalmic (Polytrim Ophthalmic Solution)
For ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic. Available as a solution and ointment. Trimethoprim and polymyxin B are rarely sensitizing, and they have a wide spectrum of action in combination.
Gram-positive: S aureus, S epidermidis,Streptococcus species (group A beta-hemolytic and nonhemolytic), S pneumoniae
Gram-negative: P aeruginosa, H influenzae, H aegyptius, E coli, K pneumoniae, P mirabilis (indole-positive), Proteus species (indole-negative), E aerogenes, C freundii, C diversus, A calcoaceticus, M lacunata (some strains), S marcescens
Tobramycin ophthalmic (Tobrex)
Like other aminoglycosides, the bactericidal activity of tobramycin is accomplished by specific inhibition of normal protein synthesis in susceptible bacteria, but very little presently is known about this action. May inhibit bacterial mRNA synthesis, causing inhibition of bacterial growth.
Ofloxacin ophthalmic (Floxin)
Pyridine carboxylic acid derivative with broad-spectrum bactericidal effect.
Ciprofloxacin ophthalmic (Ciloxan)
Inhibits bacterial growth by inhibiting DNA gyrase.
Bacitracin ophthalmic (AK-Tracin, Baciguent)
Prevents transfer of mucopeptides into growing cell wall, inhibiting bacterial growth.
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. Indicated for bacterial conjunctivitis due to Corynebacterium propinquum, S aureus, Staphylococcus epidermidis, Streptococcus mitis, S pneumoniae, or H influenzae.
Cycloplegics
Class Summary
For comfort of the eye and to prevent iris adhesion in cases of traumatic iritis.
Cyclopentolate HCl 0.5-1% (Cyclogyl)
Cyclopentolate is an anticholinergic agent that induces relaxation of the sphincter of the iris and ciliary muscles. When applied topically to the eyes, it causes rapid, intense cycloplegic and mydriatic effects that reach a peak in 15-60 min; recovery usually occurs within 24 h. The cycloplegic and mydriatic effects are slower in onset and longer in duration in patients who have dark pigmented irises.
