I. Indications

  1. Treatment of infection
    1. Bacterial Conjunctivitis
  2. Prophylaxis in Eye Injury (avoid Aminoglycosides due to toxicity risk)
    1. Corneal Abrasion
    2. Chemical Eye Burn

II. Preparations: Most cost effective agents

  1. First-line
    1. Trimethoprim-Polymyxin B (Polytrim) solution
    2. Erythromycin 0.5% ointment
  2. Broad-spectrum
    1. Gentamicin (Gentak) 0.3% ointment or solution
    2. Tobramycin (Tobrex) 0.3% solution (ointment is not generic and is expensive)
    3. Ciprofloxacin (Ciloxan) 0.3% ointment or solution
    4. Ofloxacin (Ocuflox) 0.3% solution

III. Preparations: First-Line general purpose

  1. Trimethoprim-Polymyxin B (Polytrim) solution
  2. Sulfacetamide 10% (Bleph-10) ointment or Solution
    1. Typically avoid due to low efficacy and reaction risk

IV. Preparations: First-Line Macrolides (especially if Chlamydia suspected)

  1. Erythromycin 0.5% ointment
  2. Azithromycin 1% (Azasite) solution
  3. Bacitracin ointment (used in stye)

V. Preparations: Broad-Spectrum Fluoroquinolones

  1. Precautions
    1. Reserve for severe infections to prevent resistance
  2. Besifloxacin (Besivance) 0.6% solution
  3. Ciprofloxacin (Ciloxan) 0.3% ointment or solution
  4. Gatifloxacin (Zymar) 0.3%
  5. Levofloxacin (Iquix) 1.5% or (Quixin) 0.5% solution
  6. Moxifloxacin (Vigamox) 0.5% solution
  7. Ofloxacin (Ocuflox) 0.3% solution

VI. Preparations: Broad-spectrum Aminoglycosides

  1. Precautions
    1. Reserve for severe infections to prevent resistance
    2. Avoid if Corneal Injury (toxicity risk)
  2. Gentamicin (Gentak) 0.3% ointment or solution
  3. Tobramycin (Tobrex) 0.3% ointment or solution

VII. Preparations: To Avoid

  1. Neomycin (topical reactions are common)

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