Inappropriate use of over-the-counter antibiotic putting vision at risk
in Ageing, Dry eye and blepharitis, Education, Ocular Surface Disease, News
2 Apr 2015
Doctors from Sydney’s Save Sight Institute have warned that a common first-line approach by general practitioners, pharmacists and optometrists to treating ‘red eye’ can delay the diagnosis and treatment of microbial keratitis, an ophthalmic emergency which can lead to reduced vision and in serious cases, loss of the eye.
Chloramphenicol is a common topical antibiotic which is now available over-the-counter in Australia, sold under a number of different brand names. It plays an important role in the management of bacterial conjunctivitis, mild corneal injuries and post-operative recovery.
Manufacturers do not recommend its use under the following circumstances: photophobia, severe eye pain, reduced vision, contact lens wear and other conditions.
However, according to Professor Stephanie Watson “The extent to which pharmacists screen for these symptoms is unknown, difficult to quantify and demands further research.
“Chloramphenicol is bacteriostatic, rather than bactericidal. This means that it is not suitable to treat microbial keratitis. Despite this, we have seen a number of patients who were given chloramphenicol as a first line approach, which of course did not treat the microbial keratitis, but did delay its appropriate diagnosis and intervention. The delay can be catastrophic.”
In one case, a 69 year old woman obtained chloramphenicol drops and ointment from her pharmacist, and self-administered without medical consultation. Her medical history of rheumatoid arthritis related dry eye put her at higher risk of microbial keratitis, but this was not taken into account. After three weeks, her vision continued to deteriorate and despite seeking ophthalmological management and appropriate treatment, the organism became multi-resistant, the infection progressed and the eye required removal.
In another recent case, a 16 year old girl was advised by her optometrist to use chloramphenicol eye drops. This patient was also at a higher risk of developing microbial keratitis because of orthokeratology contact lens wear. After a week of worsening symptoms she sought treatment from an ophthalmologist. Her eye was left with a scar and a slow to heal corneal ulcer, reducing her vision permanently.
Dr Dana Robaei urges all non-ophthalmic health professionals, including general practitioners and pharmacists, to ensure they are fully aware of the symptoms and signs of microbial keratitis. “The increased availability of over-the-counter therapies requires better education to understand risk factors associated with microbial keratitis. Chloramphenicol is not an appropriate treatment course. The condition requires urgent consultation with an ophthalmologist, who is the only medical specialist with the requisite training and resources to diagnose and manage this sight-threatening condition.”
Clinical and Experimental Ophthalmology, Letter to the Editor
Clinical and Experimental Ophthalmology, Volume 43