Treatment of Eye Infections
The treatment for eye infections depends on the specific type of infection, with bacterial conjunctivitis typically requiring a 5-7 day course of broad-spectrum topical antibiotics such as moxifloxacin 0.5% ophthalmic solution administered three times daily. 1
Types of Eye Infections and Their Treatments
Bacterial Conjunctivitis
Diagnosis
- Red eye with purulent or mucopurulent discharge
- Crusting of eyelids, especially upon waking
- Gritty sensation in the eye
- No significant vision loss
Treatment
First-line therapy: Broad-spectrum topical antibiotic for 5-7 days 1
- Moxifloxacin 0.5% ophthalmic solution: 1 drop in affected eye 3 times daily for 7 days 2
- Gatifloxacin ophthalmic solution for susceptible strains of Staphylococcus, Streptococcus, and Haemophilus 3
- No clinical evidence suggests superiority of any particular antibiotic, allowing selection of the most convenient or least expensive option 1
Special considerations:
- For suspected gonococcal infection: Obtain conjunctival cultures and Gram staining 1
- For MRSA consideration (especially in nursing home residents): Consider alternative antibiotics based on local resistance patterns 1
- Patients can typically return to work or school after 24 hours of antibiotic treatment 1
Bacterial Keratitis (Corneal Infection)
Diagnosis
- Painful red eye with corneal infiltrate
- Photophobia
- Decreased vision
- Risk factors: contact lens wear, corneal trauma, ocular surface disease
Treatment
Central or severe keratitis (deep stromal involvement or infiltrate >2mm with suppuration): 4
- Loading dose: Topical antibiotics every 5-15 minutes, then hourly
- Consider fortified topical antibiotics for large/visually significant infiltrates, especially with hypopyon
- Single-drug therapy with fluoroquinolone has shown equal efficacy to combination therapy with fortified antibiotics
Less severe keratitis: 4
- Topical fluoroquinolones (ciprofloxacin 0.3%, ofloxacin 0.3%, or levofloxacin 1.5%)
- Ocular ointments may be useful at bedtime as adjunctive therapy
Adjunctive therapy: 4
- Cycloplegic agents to decrease pain from inflammation and prevent synechiae formation
- Avoid patching or bandage contact lens in contact lens-related cases
Fungal Eye Infections
Diagnosis
- Slow onset
- Indolent course
- Risk factors: trauma with vegetable matter, immunosuppression, prolonged antibiotic use
Treatment for Fungal Keratitis
- Topical antifungal agents: 4
- Amphotericin B (0.15%-1%) eye drops
- Natamycin 5% suspension
- Voriconazole 1% solution
Treatment for Fungal Endophthalmitis
For fluconazole/voriconazole-susceptible isolates: 4
- Fluconazole (loading dose 800 mg, then 400-800 mg daily) OR
- Voriconazole (loading dose 400 mg IV twice daily for 2 doses, then 300 mg IV/oral twice daily)
For resistant isolates: 4
- Liposomal amphotericin B, 3-5 mg/kg IV daily, with or without oral flucytosine
With macular involvement: 4
- Above systemic therapy PLUS intravitreal injection of amphotericin B deoxycholate (5-10 μg/0.1 mL) or voriconazole (100 μg/0.1 mL)
Treatment duration: At least 4-6 weeks, depending on resolution of lesions 4
Endophthalmitis (Intraocular Infection)
Diagnosis
- Severe eye pain
- Marked decrease in vision
- Hypopyon (pus in anterior chamber)
- Risk factors: recent eye surgery, penetrating trauma, or hematogenous spread
Treatment
- Immediate ophthalmology referral - this is a medical emergency 5, 6
- Vitreous tap for culture and intravitreal antibiotics
- Vitrectomy may be necessary in severe cases
- All patients with candidemia should have a dilated retinal examination within the first week of therapy 4
Prevention of Eye Infections
- Frequent handwashing
- Avoid sharing towels and pillowcases
- Change pillowcases frequently during infection
- Avoid touching or rubbing eyes 1
- For contact lens wearers:
- Appropriate lens care and frequent replacement
- Remove lenses at night
- Replace lens case regularly 1
When to Refer to an Ophthalmologist
- Visual loss
- Moderate or severe pain
- Severe purulent discharge
- Corneal involvement
- Lack of response to therapy after 3-4 days
- Recurrent episodes
- History of herpes simplex virus eye disease
- Immunocompromised status 1
Common Pitfalls to Avoid
- Overuse of antibiotics for viral conjunctivitis
- Prolonged use of corticosteroids without ophthalmology supervision
- Failure to recognize potentially serious causes of conjunctivitis
- Inadequate hygiene education
- Delayed referral for severe or non-responsive cases 1
- Patching eyes with contact lens-related abrasions (increases risk of infection) 4
Remember that while most ocular infections are benign, others can be associated with devastating visual consequences. Early diagnosis and prompt treatment are essential to prevent vision loss.