Ocular Burns and Chemical Injuries Medication

Updated: May 31, 2017
  • Author: Joshua J Solano, MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
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Medication

Medication Summary

The goal of therapy is to reduce inflammation, pain, and risk of infection. If secondary glaucoma develops, administer ocular pressure–lowering medications. Agents that are commonly used in patients with ocular burns include cycloplegic mydriatics, ophthalmic antibiotics, analgesics, and toxoids.

Several proprietary products are now on the market to be used in the industrial setting for chemical ocular exposures. [29]

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Cycloplegic/Mydriatics

Class Summary

The goal of therapy is to reduce inflammation, pain, and risk of infection. If secondary glaucoma develops, administer ocular pressure–lowering medications. Agents that are commonly used in patients with ocular burns include cycloplegic mydriatics, ophthalmic antibiotics, analgesics, and toxoids.

Homatropine (Isopto-homatropine)

Homatropine blocks the responses of the sphincter muscle of the iris and the muscle of the ciliary body to cholinergic stimulation, producing pupillary dilation (mydriasis) and paralysis of accommodation (cycloplegia). It induces mydriasis in 10-30 minutes and cycloplegia in 30-90 minutes; these effects last up to 48 hours.

Atropine ophthalmic (Isopto-atropine)

Atropine ophthalmic acts at parasympathetic sites in smooth muscle to block the response of the sphincter muscle of the iris and the muscle of the ciliary body to acetylcholine; its effects produce mydriasis and cycloplegia.

Scopolamine ophthalmic (Isopto-hyoscine)

Scopolamine ophthalmic blocks the action of acetylcholine at parasympathetic sites in smooth muscle, producing pupillary dilation (mydriasis) and paralysis of accommodation (cycloplegia).

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Antibiotics, Ophthalmic

Class Summary

Patients with burns to the cornea, conjunctiva, and sclera are usually treated with prophylactic topical administration of broad-spectrum ophthalmic antibiotic drops or ointment (eg, tobramycin, gentamicin, ciprofloxacin, norfloxacin, or bacitracin). Neomycin and sulfa drugs are used less frequently, because of the high incidence of sensitivity. Patients with burns to the skin (eg, eyelids) are rarely given prophylactic antibiotics.

Tobramycin ophthalmic (Tobrex, AKTob)

Tobramycin ophthalmic interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits, resulting in a defective bacterial cell membrane. It is available as a solution and as an ointment.

Gentamicin (Gentak, Garamycin)

Gentamicin is an aminoglycoside antibiotic used for gram-negative bacterial coverage. It is commonly used in combination with an agent against gram-positive organisms.

Ciprofloxacin ophthalmic (Ciloxan)

Ciprofloxacin ophthalmic is a bactericidal antibiotic that inhibits bacterial DNA synthesis and, consequently, growth by inhibiting DNA-gyrase in susceptible organisms. It is indicated for pseudomonal infections and those due to multidrug-resistant gram-negative organisms.

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Ophthalmic NSAIDs

Class Summary

Some ophthalmologists are advocating the application of diclofenac drops. This therapy may prove to be an effective alternative to patching in patients with insults to the cornea, permitting the patient to maintain binocular vision during treatment.

Diclofenac ophthalmic (Voltaren Ophthalmic)

Diclofenac ophthalmic has analgesic properties. It inhibits prostaglandin synthesis by decreasing the activity of cyclooxygenase, which in turn results in decreased formation of prostaglandin precursors. It also facilitates the outflow of aqueous humor and decreases vascular permeability.

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Toxoids

Class Summary

Toxoids are used to induce active immunity.

Tetanus toxoid adsorbed or fluid

Tetanus toxoid is used to induce active immunity against tetanus in selected patients. Tetanus and diphtheria toxoids are the immunizing agents of choice for most adults and children older than 7 years. Booster doses must be administered to maintain tetanus immunity throughout life. Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product.

In children and adults, tetanus toxoid may be administered into the deltoid or midlateral thigh muscles. In infants, the preferred site of administration is the midthigh laterally.

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