Maxitrol Eyedrops for Conjunctivitis
Maxitrol (neomycin/polymyxin B/dexamethasone) should be avoided in most cases of conjunctivitis and is contraindicated in viral conjunctivitis, particularly herpes simplex virus (HSV) infections. 1, 2
Critical Contraindications
Never use Maxitrol or any steroid-containing preparation in HSV conjunctivitis, as topical corticosteroids potentiate HSV epithelial infections and worsen disease outcomes. 1, 2 This represents a serious risk to vision and can lead to corneal perforation.
For adenoviral conjunctivitis, antibiotics (including the neomycin/polymyxin B components of Maxitrol) should be avoided as they provide no benefit and risk adverse effects. 1, 2 Additionally, corticosteroids can potentially prolong adenoviral infections and viral shedding. 1, 3
Limited Appropriate Use
Maxitrol may only be considered in severe bacterial conjunctivitis with significant inflammation where both antimicrobial coverage and anti-inflammatory effects are needed simultaneously. 4, 5 However, this represents a narrow indication.
When Steroids Are Appropriate in Conjunctivitis:
Topical corticosteroids (without antibiotics) are reserved for:
- Severe adenoviral conjunctivitis with marked chemosis, severe eyelid swelling, epithelial sloughing, or membranous/pseudomembranous conjunctivitis 1, 2
- Corneal subepithelial infiltrates (appearing 1+ weeks after viral conjunctivitis onset) causing blurring, photophobia, and decreased vision 1, 2
- Allergic conjunctivitis that is severe and refractory to antihistamines/mast cell stabilizers 3
In these scenarios, a steroid-only preparation (not Maxitrol) is preferred, with safer options like loteprednol or fluorometholone to minimize intraocular pressure elevation and cataract risk. 1
Mandatory Monitoring if Steroids Are Used
Patients prescribed any topical corticosteroid for conjunctivitis require:
- Re-evaluation within 1 week 1, 2
- Periodic intraocular pressure measurement to detect glaucoma 1, 2
- Pupillary dilation examination to evaluate for cataract formation 1, 2
- Slow taper to minimum effective dose once inflammation is controlled 1, 2
Preferred Treatment Approaches
For bacterial conjunctivitis: Use broad-spectrum fluoroquinolone (moxifloxacin 0.5%) three times daily for 5-7 days without steroids. 3
For viral conjunctivitis: Symptomatic management with artificial tears, cold compresses, topical antihistamines, and oral analgesics is sufficient for most cases. 1, 2
For allergic conjunctivitis: Topical antihistamine/mast cell stabilizer combination drops are first-line. 3
Common Pitfall
The most dangerous error is using Maxitrol (or any steroid) empirically for "red eye" without ruling out HSV infection, which can lead to devastating corneal complications. 1, 2 Always obtain a careful history of vesicular rash, dendritic ulcers, or prior HSV keratitis before considering any steroid-containing preparation.