TOPICAL TREATMENT OF EXTERNAL OCULAR INFLAMMATION

HERMAN NDJAMEN

CONJUNCTIVACONJUNCTIVITIS

INFECTIOUS NON-INFECTIOUS

VIRAL BACTERIAL FUNGAL/PARASITIC IRRITATIVE

ALLERGIC

NON-GONOCOCCAL/

ACUTEGONOCOCCAL/ HYPERACUTE

CHLAMYDIAL/ CHRONIC

General principle of Treatment

• ETIOTROPIC TREATMENT• SYMPTOMATIC• PATHOPHYSIOLOGY

VIRAL CONJUNCTIVITIS

• Successful and rapid treatment involves the use of combined therapy

- 0,1% dexamethasone + 0,4% povidone-iodine - Cidofovir 0,5%(combination of dexamethasone & Tobramycin) - Emadastine/Azelastine (antihistamine)

DOSAGES

• Dexamethasone 1-2 drops QID /not more than 1week

• Povidone-iodine 1-2drops QID• Cidofovir/Tobradex 1-2drops QID 5 to 7days• Emadastine/Azelastine 1-2drops QID/3 weeks

Non-Gonococcal Conjunctivitis The approach or non-gonococcal Conjunctivitis involves the use of Broad spectrum antibiotics together with saline rinsing. Possible effective antibiotics include:

First Line Broad spectrum drugs

- Erythromycin Ointment - Sulfacetamide Drops - Polymixin / Trimethoprim Drops (Trimethoprim 1mg, polymyxin B sulfate 10000 Units/mL)

Other Antibiotics which May be used include:

Gentamicin/Tobramycin Bacitracin Ciprofloxacin Ofloxacin Levofloxacin Tetracylin

DOSAGESDrug Trade Name Dosage

Erythromycin ointment ilotycin 1,25cm QID for 5 to 7 days

Sulfacetamide Drops 10% Bleph-10, Sulf-10 1-2 drops QID for 5 to 7 days

Polymixin/Trimethoprim drops

Polytrim 1 drop every 3 hours for 7-10 days

Gentamicin Gentak 1-2 drops every 4 hours for 5 to 7 days

Tobramycin Tobrex See above

Ofloxacin Ocuflox 1-2 drops QID for 5 to 7 days

Ciprofloxacin Ciloxan 0,3% eyedrops 1-2 drops QID

Levofloxacin Quixin 0,5% 1-2 drops QID for 5 to 7 days

Tetracyclin Achromycin 1-2 drops QID for 5 to 7 days

Gonococcal Conjunctivitis

• The principle of treatment of these types of conjunctivitis should involve antibiotic sensitivity testing.

• Generally Combined treatment of eyedrops and Systemic antibiotic injection is Indicated,

• The systemic antibiotic of choice is the 3rd and 4th generation cephalosporin

• Drops used involve Erythromycin 0,5%,Tetracyclin1%

Dosages

• Ceftriaxone 1g IM single injection (no corneal involvement)

• Ceftriaxone 1-2g /day IM for 5 days (with corneal involvement)

TRACHOMA

• Topical antibiotics which have proven to be effective in trachoma include Sulfonamides, Tetracyclins, Erythromycin and Rifampin used four times per day for a period of 6 weeks

Allergic/Irritative Conjunctivitis

• First Line Antihistamine/Decongestant (ocuhist ophthalmic - Naphazoline + Pheniramine)• Second Line Mast cell stabilizer/ NSAID drops (Ketorolac, Chromolyn 4% Diclofenac* For severe allergy, first and second line therapy may be used together

Dosages

• Ocuhist is given as 1-2 drops QID for not more than 3 weeks

• The second line therapy is given as 1-2 drops BID for not more than 3 weeks

• NSAID 1-2 drops QID

CORNEAL INFLAMMATION

• Viral : - Herpex Simplex Keratitis - Varicella Zoster Keratitis

• Bacterial:

Herpex simplex keratitis

• Ganciclovir ophthalmic gel 0.15% - 5 times daily• Trifluridine 1% drops - 9 times daily• Vidarabine 3% ointment - 5 times daily

• The course of treatment may be as long as 2 weeks.

• N/B; topical steroids should never be used in this case.

Varicella zoster Keratitis

Epithelial keratitis† Debridement or none

Stromal keratitis† Topical steroids

Neurotrophic keratitis† Topical lubrication

Topical antibiotics for secondary infections

Tissue adhesives and protective contact lenses to prevent corneal perforation