From the Research
Topical moxifloxacin 0.5% is the recommended antibiotic for lacrimal stones due to its high potency, fast in vitro 'speed-to-kill', and favorable pharmacokinetic/pharmacodynamic characteristics, as shown in a study published in 2019 1. The use of topical antibiotics such as moxifloxacin can help treat associated infection and inflammation in the lacrimal system. Some key points to consider when using topical antibiotics for lacrimal stones include:
- Topical antibiotics alone are generally insufficient for treating lacrimal stones, as they don't dissolve the stones themselves.
- Lacrimal stones often require additional interventions such as lacrimal irrigation, probing, or in some cases surgical removal through dacryocystorhinostomy.
- Warm compresses applied to the inner corner of the eye for 5-10 minutes several times daily can help relieve symptoms by promoting drainage.
- If symptoms persist despite antibiotic treatment, referral to an ophthalmologist is necessary for definitive management of the stones. A recent study published in 2024 found that there is low in vitro efficacy of commonly used antimicrobials such as β-lactams and fluoroquinolones, and recommends opting for trimethoprim/sulfamethoxazole and gentamicin for systemic and topical single-agent treatments 2. However, based on the most recent and highest quality study, moxifloxacin 0.5% is still the recommended antibiotic for lacrimal stones. It's also worth noting that the resistance rates for trimethoprim/sulfamethoxazole and gentamicin were 8.6% and 3.4%, respectively, in the 2024 study 2. In contrast, the resistance rate for moxifloxacin was 30.4% in the same study, but it was still found to be effective in reducing bacterial colonization in the conjunctival sac, as shown in a study published in 2019 1.