What is the treatment for an eye infection that causes pain with eye movement?

Treatment of Eye Infection Causing Pain with Eye Movement

Topical antibiotics are the first-line treatment for bacterial keratitis or conjunctivitis causing pain with eye movement, with fluoroquinolones such as gatifloxacin being effective against common causative organisms. 1, 2

Diagnosis and Assessment

Eye pain with movement is a concerning symptom that often indicates inflammation of deeper ocular tissues or orbital structures. Before initiating treatment, proper diagnosis is essential:

• Pain with eye movement specifically suggests orbital inflammation, scleritis, or keratitis with significant inflammation 1, 3
• Associated symptoms to evaluate include visual acuity changes, discharge, redness, photophobia, and foreign body sensation 3
• Examine for corneal infiltrates, anterior chamber inflammation, and conjunctival injection 1
• Fluorescein staining should be performed to identify epithelial defects 1

Treatment Approach for Bacterial Infections

Initial Antibiotic Therapy

• For central or severe keratitis (deep stromal involvement or infiltrate >2mm):

  • Begin with loading dose of topical antibiotics every 5-15 minutes followed by hourly application 1
  • Single-drug therapy with a fluoroquinolone (e.g., gatifloxacin, ciprofloxacin, ofloxacin) is as effective as combination therapy 1
  • For gatifloxacin: instill one drop every two hours while awake (up to 8 times) on day 1, then 2-4 times daily on days 2-7 2

• For severe infections or visually significant corneal infiltrates:

  • Consider fortified topical antibiotics, especially if hypopyon is present 1
  • Subconjunctival antibiotics may be helpful for imminent scleral spread or if compliance is questionable 1

Adjunctive Therapy

• Cycloplegic agents (e.g., cyclopentolate, atropine) to decrease pain and prevent synechiae formation when anterior chamber inflammation is present 1
• Avoid corticosteroids initially until infection is controlled, as they may mask signs of infection 1
• Consider bandage contact lens for epithelial defects causing discomfort, but be aware of increased risk of secondary infection 1

Treatment for Specific Types of Eye Infections

Bacterial Conjunctivitis

• Mild bacterial conjunctivitis:

  • Often self-limiting but topical antibiotics hasten recovery 1
  • Broad-spectrum topical antibiotic (e.g., gatifloxacin) for 5-7 days 1, 2

• Moderate to severe bacterial conjunctivitis:

  • Obtain cultures if gonococcal infection is suspected 1
  • More intensive antibiotic therapy guided by laboratory results 1
  • Consider methicillin-resistant S. aureus in nursing home residents or those with healthcare exposure 1

Fungal Keratitis (Aspergillus)

• Requires emergency ophthalmologic intervention 1
• Treatment includes:
  • Topical antifungal therapy 1
  • Systemic antifungal therapy with amphotericin B, voriconazole, or itraconazole 1
  • Surgical intervention for cases with potential corneal perforation or progression despite medical therapy 1

Special Considerations

• Contact lens wearers:

  • Discontinue contact lens use immediately 1
  • Higher risk of Pseudomonas infection, which can cause rapid tissue destruction 1
  • Avoid bandage contact lens for traumatic abrasions in contact lens wearers 1

• Immunocompromised patients:

  • May have polymicrobial infections requiring broader coverage 1
  • Higher risk for fungal infections 1

• Warning signs requiring immediate ophthalmology referral:

  • Worsening pain despite treatment 1
  • Decreased visual acuity 1
  • Corneal infiltrate progression 1
  • Development of hypopyon (pus in anterior chamber) 1

Follow-up and Monitoring

• For severe infections: daily follow-up until clinical improvement is noted 1
• For mild to moderate infections: follow-up in 3-4 days if no improvement 1
• At each visit, assess:
  • Visual acuity 1
  • Size and depth of corneal infiltrate 1
  • Anterior chamber inflammation 1
  • Epithelial defect healing 1

Prevention

• Educate patients with risk factors about signs and symptoms requiring prompt consultation 1
• Treat underlying ocular surface disease (epithelial defects, tear deficiency) 1
• For contact lens wearers, emphasize proper lens hygiene and avoiding overnight wear 1