Ophthalmology

1. TOPICAL TREATMENT OF EXTERNAL
OCULAR INFLAMMATION
HERMAN
NDJAMEN

2. CONJUNCTIVA
CONJUNCTIVITIS
INFECTIOUS
NON-
INFECTIOUS
VIRAL BACTERIAL
FUNGAL/PARASI
TIC
IRRITATIVE
ALLERGIC
NON-
GONOCOCCAL/
ACUTE
GONOCOCCAL/
HYPERACUTE
CHLAMYDIAL/
CHRONIC

3. General principle of Treatment
• ETIOTROPIC TREATMENT
• SYMPTOMATIC
• PATHOPHYSIOLOGY

4. 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)

5. 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

6. 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

7. DOSAGES
Drug 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

8. 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%

9. Dosages
• Ceftriaxone 1g IM single injection (no corneal
involvement)
• Ceftriaxone 1-2g /day IM for 5 days (with
corneal involvement)

10. 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

11. 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

12. 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

13. CORNEAL INFLAMMATION
• Viral :
- Herpex Simplex Keratitis
- Varicella Zoster Keratitis
• Bacterial:

14. 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.

15. 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