Immediate Irrigation and Prophylactic Antibiotic Coverage
For ocular exposure to goose feces, immediately irrigate the eye with copious saline or clean water, then apply a broad-spectrum fluoroquinolone antibiotic drop such as moxifloxacin 0.5% four times daily for prophylaxis. 1
Initial Management
- Copious irrigation is the critical first step to mechanically remove fecal contaminants and reduce bacterial load before any pharmacologic intervention 2
- After irrigation, examine the eye for corneal epithelial defects using fluorescein staining, as any epithelial disruption significantly increases infection risk 1
Antibiotic Selection
Moxifloxacin 0.5% ophthalmic solution is the preferred prophylactic antibiotic for fecal contamination due to its broad-spectrum coverage against both gram-positive and gram-negative organisms, including enteric bacteria commonly found in bird feces 1, 3
Dosing Protocol
- Apply moxifloxacin 0.5% four times daily if corneal fluorescein staining is present or if there is any epithelial defect 1
- Alternative fluoroquinolones include levofloxacin or ofloxacin, which provide similar broad-spectrum coverage 1, 4
- Continue treatment for 5-7 days or until epithelial healing is complete 1
Clinical Monitoring
- Reassess within 24-48 hours to evaluate for signs of developing keratitis, including increased pain, discharge, stromal infiltrate, or worsening epithelial defect 1
- If no improvement or worsening occurs within 48 hours, consider reculture and modification of antibiotic therapy 1
Important Caveats
- Do not use combination steroid-antibiotic drops (such as Tobradex) as initial therapy, as corticosteroids should only be added after 2-3 days of antibiotic-only therapy once infection is controlled 5
- Avoid tapering antibiotics below therapeutic dosing, as subtherapeutic levels increase antibiotic resistance risk 1, 5
- Be aware that prolonged antibiotic use can cause corneal toxicity and should be discontinued once the infection risk has passed 1