Intraocular Foreign Body (IOFB) Medication

Updated: May 18, 2017
  • Author: Ferenc Kuhn, MD, PhD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Medication

Medication Summary

The goal of pharmacotherapy is to reduce morbidity and to prevent complications, such as posterior synechia (pupillary dilation), inflammation (corticosteroids), and intraocular pressure (IOP) elevation.

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Antibiotics

Class Summary

For use in every case (systemic and topical); intravitreal usually only if infection is present or the case is high risk.

Vancomycin (Vancocin, Vancoled, Lyphocin)

DOC for gram-positive coverage. Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in the treatment of septicemia and skin structure infections. Indicated for patients who cannot receive, or have failed to respond to penicillins and cephalosporins, or have infections with resistant staphylococci. For abdominal penetrating injuries, it is combined with an agent active against enteric flora and/or anaerobes.

To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use creatinine clearance to adjust dose in patients diagnosed with renal impairment.

Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing gastrointestinal or genitourinary procedures.

Ceftazidime (Ceptaz, Fortaz, Tazicef, Tazidime)

First-line choice for intravitreal gram-negative coverage. 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.

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Antifungals

Class Summary

Their mechanism of action may involve an alteration of RNA and DNA metabolism or an intracellular accumulation of peroxide that is toxic to the fungal cell.

Amphotericin B (Amphocin, Fungizone)

Produced by a strain of Streptomyces nodosus; can be fungistatic or fungicidal. Binds to sterols, such as ergosterol, in the fungal cell membrane, causing intracellular components to leak with subsequent fungal cell death.

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