How to administer ciprofloxacin (Cipro) ophthalmic eye drops?

From the Guidelines

To use Cipro (ciprofloxacin) ophthalmic eye drops correctly, follow the prescribed instructions carefully, typically 2-4 times daily for 7-14 days, depending on your condition, as stated in the bacterial keratitis preferred practice pattern 1. When using Cipro ophthalmic eye drops, it is essential to prioritize proper administration to ensure effectiveness and minimize the risk of complications.

• Wash your hands thoroughly with soap and water before handling the eye drops.
• Tilt your head back slightly or lie down, and pull down your lower eyelid to create a small pocket.
• Hold the dropper above your eye and place the prescribed number of drops (usually 1-2 drops) into this pocket, being careful not to touch the dropper tip to your eye, fingers, or any surface.
• Close your eyes gently for 1-2 minutes to allow the medication to spread across your eye surface.
• Press your finger against the inner corner of your eye for about 1 minute to prevent drainage into your tear duct.
• If you're using multiple eye medications, wait at least 5 minutes between applications. It is crucial to follow your doctor's instructions regarding frequency and duration of treatment, as most antibiotic eye drops should not be tapered below 3 to 4 times a day because low doses are subtherapeutic and may increase the risk of developing antibiotic resistance 1. The preparation of antibiotic eye drops, such as tobramycin or gentamicin, involves specific steps, including withdrawing 2 ml from an injectable vial and adding it to a 5-ml bottle of ophthalmic solution, then refrigerating and shaking well before instillation 1. However, for ciprofloxacin ophthalmic eye drops, the focus should be on completing the full course of treatment even if symptoms improve, as stopping early may allow the infection to return and potentially develop resistance to the antibiotic.

From the FDA Drug Label

Use Ciprofloxacin ophthalmic solution as prescribed by your doctor Ask your doctor if you have questions about how to use Ciprofloxacin ophthalmic solution. Important information: Ciprofloxacin ophthalmic solution is for use in the eye only. Ciprofloxacin ophthalmic solution should not be injected into the eye. If you use other medicines in your eye, wait at least 10 minutes between using Ciprofloxacin ophthalmic solution and your other eye medicines If you wear contact lenses, remove them before using Ciprofloxacin ophthalmic solution. Wait at least 15 minutes after using Ciprofloxacin ophthalmic solution before placing your contact lenses back in your eyes. Do not touch your eye, fingers, or other surfaces with the tip of the Ciprofloxacin ophthalmic solution bottle You may get bacteria on the tip of the bottle that can cause you to get an eye infection. This eye infection can lead to serious eye damage or vision loss. If you think you have gotten bacteria on the tip of the bottle or you have an eye infection, call your doctor right away. Wash your hands before each use Before you use a bottle of Ciprofloxacin ophthalmic solution for the first time: Check the expiration date on the bottle before use. Do not use Ciprofloxacin ophthalmic solution if the expiration date has passed. Check that the seal on the dust cover is not broken or missing. Do not use the medicine if the seal is broken or missing. Call your doctor or pharmacist Each time you use Ciprofloxacin ophthalmic solution: Step 1: Turn the dust cover clockwise to break the seal. Step 2: Remove the dust cover and throw it away. Step 3: Turn the tan coloured cap anti-clockwise and remove. Place the cap on a clean flat surface. Step 4: Tilt your head backwards. Step 5: Turn the bottle upside down and place the tip of the bottle close to your eye Do not touch your eye with the tip. Pull your lower eyelid downward and look up. Gently squeeze the bottle and let 1 drop fall into the space between your lower eyelid and your eye. If a drop misses your eye, repeat Step 5. Step 6: Replace the tan coloured cap back on the bottle and turn it clockwise to close. Step 7: Remove any extra solution from skin around the eyes with a tissue If your doctor has told you to use drops in both eyes, repeat Step 5 for your other eye.

To use Ciprofloxacin ophthalmic eye drops, follow these steps:

• Wash your hands before each use
• Check the expiration date and seal on the bottle before use
• Remove the dust cover and turn the tan colored cap anti-clockwise
• Tilt your head backwards and place the tip of the bottle close to your eye
• Gently squeeze the bottle and let 1 drop fall into the space between your lower eyelid and your eye
• Replace the cap and remove any extra solution from skin around the eyes
• If using in both eyes, repeat the steps for the other eye Key points to remember:
• Use as prescribed by your doctor
• Do not touch your eye with the tip of the bottle
• Wait at least 10 minutes between using Ciprofloxacin ophthalmic solution and other eye medicines
• Wait at least 15 minutes after using Ciprofloxacin ophthalmic solution before placing contact lenses back in your eyes 2

From the Research

Administration of Cipro Ophthalmic Eye Drops

• The dosing schedule for ciprofloxacin ophthalmic solution 0.3% is as follows: 1 to 2 drops every 30 minutes for 6 hours, then hourly for the remainder of day 1; 1 to 2 drops every hour on days 2 and 3; 1 to 2 drops every 2 hours on days 4 and 5, followed by 1 to 2 drops every 4 hours on days 6 to 14 3.
• In pediatric patients, ciprofloxacin ophthalmic solution 0.3% can be administered every 2 hours on days 1 and 2, followed by every 4 hours on days 3 through 7 4.
• For the reduction of bacterial flora on the human conjunctiva, ciprofloxacin 0.3% can be administered as 1 drop every 5 minutes for 3 doses 5.

Efficacy and Safety

• Ciprofloxacin ophthalmic solution 0.3% has been shown to be equivalent clinically and statistically to standard therapy (fortified tobramycin-cefazolin) for the treatment of bacterial corneal ulcers, with a clinical success rate of 91.5% 3.
• In the treatment of blepharitis and blepharoconjunctivitis, ciprofloxacin ophthalmic solution has been shown to be safe and effective, with a bacteriological eradication rate of 93.7% 6.
• In pediatric patients with acute bacterial conjunctivitis, ciprofloxacin ophthalmic solution 0.3% has been shown to be safe and effective, with a microbiological eradication rate of 90.1% 4.

Drug Delivery Systems

• Hydrophilic contact lenses (Acuvue) can be used as a drug delivery system for ciprofloxacin, releasing approximately 1000 microg of the drug after soaking for 1 hour in 0.3% eye drop solution 7.
• The use of Acuvue contact lenses soaked in ciprofloxacin solution can result in higher aqueous humour concentrations compared to the use of eye drops, with a mean concentration of 1.23 microg x ml(-1) 7.