Eye Infections

Anterior:

Lid hygiene with daily warm compresses and gentle scrubbing

Posterior:

Lid hygiene (as above) initially
If no improvement use:
Doxycycline 100 mg (child ≥8 years: 2mg/kg) PO OD

The exact aetiology is unclear, but infection be a complication of seborrhoeic dermatitis, or acne rosacea with secondary Staphylococcus or Streptococcus involvement

Duration:

Treat for 3-8 weeks

Consider warm compresses BID.

There is little evidence that treating with topical antibiotics improves outcome, only consider this in patients with frequent hordeola who do not achieve adequate improvement with warm compresses and removal of lid margin debris.

Adults:

Tetracycline 1% ointment applied to the affected eye at night + Chloramphenicol 1% ointment or 0.5% eye drop solution QID.

Child:

Tetracycline 1% ointment applied to the affected eye TID-QID

Removal of the eyelash often aids resolution

Consider warm compresses BID.

If signs of cellulitis see Pre-septal and Orbital Cellulitis in Eye Infections chapter.

Topical antibiotics are not indicated. Incision and drainage is sometimes necessary for persistent or recurrent meibomian abscess

Ophthalmology review required.

See Sepsis and Directed Therapy for Blood Stream Infections chapter

Antimicrobial 

Comments and Duration of Therapy

Antibiotics are often not required.

If severe or not resolving, use:

Chloramphenicol 1% ointment or 0.5% eyedrops 1 drop to the affected eye 1-2 hourly for the first 24 hours. Thereafter QID.

Alternative:

Tetracycline 1% ointment to the affected eye TID

Chloramphenicol can cause contact hypersensitivity reactions that can be severe.

If failing to respond to antibiotic therapy, significant pain, loss of vision or photophobia, refer immediately to ophthalmologist.

Duration:

Treat for a total of 7 days.

Azithromycin 1g (child >6months 20mg/kg) PO for 1 dose

Alternative or if <6 months old:

Tetracycline 1% ointment BID to both eyes for at least 6 weeks. Repeat after interval of 6 months for another 6 weeks if necessary.

In areas where Trachoma is prevalent, regular face washing and treatment of all household contacts is recommended. It is not prevalent in Timor-Leste.

Mild:

Cloxacillin 500mg (child 12.5mg/kg) PO

Alternative:

Cotrimoxazole 160/800 mg (child 4/20 mg/kg) PO BID

OR

Clindamycin 450 mg (child 10mg/kg) PO TID

Moderate or Severe:

Cloxacillin 2g (child 50mg/kg) IV QID

Alternative:

Cefazolin 2g (child 50mg/kg) IV TID

OR

Clindamycin 600mg (child 15mg/kg) IV TID

Take blood cultures if systemically unwell.

Duration:

Change to oral antibiotics when improving, treat for a total of 7 days.

Cloxacillin 2g (child: 50mg/kg up to 2g) IV QID

PLUS

Ceftriaxone 2g (child: 50mg/kg) IV OD

Alternative:

If cloxacillin is not available replace this with:

Cefazolin 2g (child 50mg/kg) IV TID

OR

Clindamycin 600mg (child 15mg/kg) IV TID

When improving, change to:

Amoxicillin/Clavulanic acid 500/125mg (child 25/6.25 mg/kg) PO TID

Take blood cultures if systemically unwell.

Pathogens include Staphylococcus aureus, Haemophilus spp., Streptococcus spp., and anaerobic bacteria. Infection can be caused by fungi in immunocompromised patients or those with diabetes. If this is suspected clinically, antifungal cover will be required.

Duration:

Treat for a total of 14 days.

Consider brain abscess if there is intracranial spread of infection seen on CT. See Brain abscess and Subdural Empyema in Chapter 4: Central Nervous System Infections.

Chloramphenicol 1% ointment or 0.5% solution 1 drop to the affected eye Q1H initially

Alternative:

Ciprofloxacin 0.3% solution Q1H

Frequency should be decreased according to clinical response under supervision of an ophthalmologist.

Corneal scraping for culture of the specimen should be performed by ophthalmologist

Strict hourly dosing (including overnight) for the first 48 hours improves outcomes. Treatment may need to be supplemented with subconjunctival injection by an ophthalmologist if there is pus present in the anterior chamber.

Natamycin eye drops, 1 drop every 1-2 hours. Reduce to TDS / QID after 3-4 days.

Corneal scraping with culture of the specimen should be performed by ophthalmologist

Duration:

Treat for 2-3 weeks until resolution of infection.

Apply eye shield.

Give:

Ciprofloxacin 750mg (child 20mg/kg) PO BID

Duration:

Treat for 5-7 days

Cloxacillin 500mg (child 12.5mg/kg) PO QID

Alternative:

Cotrimoxazole 160/800 mg (child 4/20 mg/kg) PO BID

OR

Clindamycin 450 mg (10mg/kg) PO TID

Swab discharge for culture.

Refer to Ophthalmology for dacryocystorhinostomy (DCR) surgery.

Duration:

Treat for 7 days

No need for antibiotics

Refer to Ophthalmology for dacryocystorhinostomy (DCR) surgery