| Eye Condition |
Possible therapeutic alternatives |
| Blepharitis (eyelid) |
Common pathogens |
(Topical ointment ) bacitracin or erythromycin applied 2 to 4 times per day. Clean eyelid daily. |
| Conjunctivitis: |
Common pathogens |
| Erythromycin (Ilotycin): ½" of ointment q3-4h or bid-qid. [ointment 0.5%] or |
| Gentamycin (Garamycin): 1-2 drops every 2-4 hours or ½" ointment bid-tid. [0.3% oint/soln] or |
| Neosporin ( neomycin, bacitracin, polymyxin): 1-2 drops q1-6h or ½" oint q3-4h. or |
| Polytrim ( 1 mg trimethoprim/ polymyxin B sulfate 10,000 units): mild to moderate infections, instill 1 drop q3h (maximum of 6 doses per day) x 7 to 10 days. |
Sulfacetamide (Bleph-10, Sulamyd):
Instill 1-2 drops every 2-3 hours initially. Dosages may be tapered by increasing the time interval between doses as the condition responds (e.g. qid). Usual duration: 7-1 0 days. or ½" ointment q3-8h. |
Tobramycin (Tobrex):
Solution: mild to moderate 1-2 drops q4h.
Severe infections, instill 2 drops into the eye(s) hourly until improvement, following which treatment should be reduced prior to discontinuation. |
| TobraDex (Tobra + dexamethasone): 1-2 drops every 2 to 6 hours or ½" ointment 2 to 4 times daily. |
Ciprofloxacin (Ciloxan).
Corneal ulcers: 2 drops q15 minutes x six hours, then 2 drops every 30 minutes for the remainder of the first day. Day #2: instill 2 drops in the affected eye hourly. Day 3rd -14th: , place 2 drops in the affected eye q4h. Treatment may be continued after 14 days if corneal re-epithelialization has not occurred.
Conjunctivitis: 1-2 drops every 2 hours while awake x 2 days, then 1-2 drops every 4 hours while awake x five days. Ointment: Apply a ½" ribbon into the conjunctival sac tid x 2 days, then apply a ½" ribbon bid x 5 days. |
Ofloxacin (Ocuflox):
bacterial conjunctivitis: 1-2 drops q2-4 hours x 2 days, then Instill 1-2 drops four times daily x 5 days.
Corneal ulcers/keratitis: Instill 1-2 drops every 30 minutes, while awake. Awaken at approximately 4 and 6 hours after retiring and instill 1-2 drops x 2 days. Then Instill 1-2 drops hourly, while awake x 5 days. Then Instill 1-2 drops, four times daily x 3 days. |
|
| Keratitis (Cornea) H.Simpex |
|
Trifluridine (Viroptic): 1 drop q1h (9 times per day) for up to 21 days. |
Keratitis
(varicella-zoster) |
|
Famciclovir 500mg po tid or Valacyclovir 1 gram po tid or Acyclovir 800mg po 5 times per day. |
| Vision- threatening bacterial infection
>1.5 mm diameter ulcer, other. |
|
Fortified ophthalmic drops
(Topical)
Usual regimen: Fortified tobramycin or gentamicin (14-15 mg/ml) q1h alternating with [ fortified Ancef (50 mg/ml) or Vancomycin (25-50mg/ml) q1h. ]
|
| Fortified Ancef (Cefazolin) (50 mg/ml): |
| Reconstitute 1 gram cefazolin powder with 5ml (200mg/ml) sterile water (without preservative) or reconstitute 500mg vial with 2.5 ml. Then you may use any of the following dilutions:
Add 1 ml to 3 ml artificial tears. Final concentration: 50 mg/ml. Refrigerate. Reported stability: 4-7 days.
Add 2 ml to 6 ml of artificial tears. Final concentration: 50 mg/ml. Refrigerate. Reported stability: 4-7 days.
Add 4 ml to 12 ml artificial tears. Final concentration: 50 mg/ml. Refrigerate. Reported stability: 4-7 days.
(Side note: when adding the cefazolin to the artificial tears, aseptically remove the dropper head in a laminar flow hood. Do not attempt to use a needle through the dropper head, which may alter the intended drop size).
Alternative: Dilute 500mg vial of cefazolin powder with 10 ml sterile water. Label: Final concentration: 50 mg/ml. Refrigerate. Stability: 7 days.
|
| Fortified Gentamicin or Tobramycin: (Usual concentration: 14 mg/ml): |
Start with the commercially available solution: Gentamicin 0.3% 5ml (15 mg/5 ml) ophthalmic solution or Tobramycin 0.3% 5ml (15 mg/5 ml) ophthalmic solution (. Add 2 ml of gentamicin or tobramycin injection (80mg/2ml) to the respective ophthalmic solution. Label:
Concentration: 14 mg/ml.
REFRIGERATE,
Expires: 7 days.
(Side note: when adding the tobramycin or gentamicin to the respective container, aseptically remove the dropper head in a laminar flow hood. Do not attempt to use a needle through the dropper head, which may alter the intended drop size).
|
| Vancomycin ophthalmic drops |
| (Usual concentration: 25-50 mg/ml). Some studies have found the 25 mg/mL concentration to have similar efficacy compared to the 50mg/ml concentration and with better patient tolerance.
Preparation (50 mg/ml): Reconstitute 500mg Vancomycin powder with 10 ml sterile water (without preservative). Alternatively, use 10ml of artificial tears. Label:
Concentration: 50 mg/ml,
REFRIGERATE;
Expires: 4 days.
Dosing: (Adult Dose) 1 drop hourly for first 24 hours, then taper gradually according to clinical improvement
|
|
Ocular Decongestants/ Anti-Allergy.
|
| Cromolyn sodium (Crolom): |
vernal conjunctivitis, keratitis, and keratoconjunctivitis 1-2 drops in each eye, 4-6 times daily, at regular intervals. |
| Ketotifen Fumarate Ophthalmic Solution 0.025% (Zaditen) |
Allergic conjunctivitis: 1 drop bid, (q8-12 hours). (non-competitive histamine antagonist and mast cell stabilizer) |
| Levocabastine (Livostin): |
Allergic conjunctivitis 1 drop in affected eye BID-QID. [susp: 0.05%] (Antihistamine) |
| Lodoxamide tromethamine (Alomide): |
Vernal keratoconjunctivitis. Dosing: 1-2 drops four times daily. [soln: 0.1%] Cromolyn-like action. |
| Naphazoline (Naphcon, Vasocon): |
Ocular decongestant. Dosing: 1 drop every 3 to 4 hours as needed up to 4 times daily. |
| Vasocon-A antazoline phosphate (0.5%), naphazoline hydrochloride (0.05%) |
Antihistamine/decongestant: Dosing: 1-2 drops 2 to 4 times daily as needed. |
| Olopatadine (Patanol): |
Allergic conjunctivitis: 1-2 drops twice daily. [0.1% soln] (selective H1-receptor antagonist and mast-cell release inhibitor) |
| Pemirolast (Alamast): |
Allergic conjunctivitis: 1-2 drops qid. |
|
