Corneal Laceration Medication

Updated: Sep 20, 2018
  • Author: Adedoyin Adesina, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Medication

Medication Summary

Recommendations include a combination of a first-generation cephalosporin (eg, cefazolin) or vancomycin and an aminoglycoside (eg, gentamicin). In addition, add clindamycin if an intraocular foreign body is present or if vegetation has contaminated the wound. The most common organisms identified in posttraumatic endophthalmitis are Staphylococcus epidermidis, bacilli species, streptococci species, and gram-negative species. Fungal endophthalmitis is a relatively rare entity but should be considered in a patient who is recently post-surgical, immunocompromised, unresponsive to antibiotic treatment, or has a history of trauma with vegetable matter. Treatment should be discussed with the ophthalmology consultant if this is suspected.

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Antibiotics

Class Summary

These agents are used in prophylaxis of endophthalmitis. Therapy must cover all likely pathogens in the context of the clinical setting.

Cefazolin

First-generation cephalosporin antibiotic for gram-positive bacterial coverage. It is commonly used in combination with an aminoglycoside to achieve broad-spectrum coverage.

Gentamicin

Aminoglycoside that provides coverage for most gram-negative organisms causing endophthalmitis.

Commonly used in combination with both an agent against gram-positive organisms and one that covers anaerobes.

Gentamicin is not the antibiotic of first choice. Consider using this aminoglycoside when penicillins or other less toxic drugs are contraindicated, when bacterial susceptibility tests and clinical judgment indicate its use, and in mixed infections caused by susceptible strains of staphylococci and gram-negative organisms.

Dosing regimens are numerous and are adjusted based on creatinine clearance and changes in the volume of distribution. May be administered IV or IM.

Clindamycin (Cleocin)

Lincosamides are useful as a treatment against serious skin and soft tissue infections caused by most staphylococci. They are also effective against aerobic and anaerobic streptococci, except enterococci.

Use in the prophylaxis of endophthalmitis when a foreign body is present or if the injury was soil or farm related to provide an effective agent against bacilli species.

Vancomycin

Potent antibiotic directed against gram-positive organisms and active against enterococci species.

It can be used as an alternative to cefazolin to provide coverage for most gram-positive organisms causing endophthalmitis.

Use in conjunction with gentamicin for prophylaxis in penicillin-allergic patients.

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

Patient should be given systemic antibiotics and NSAIDs. Also consider steroids and cycloplegics.

The decision to use steroids is at the physician’s discretion and should be made in conjunction with the ophthalmologist. The purpose of using steroids is to decrease inflammation; however, it also increases the risk of infection.

Cycloplegics and NSAIDs help to decrease pain.

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