Pre-emptive treatment following a penetrating eye injury

Pre-emptive treatment following a penetrating eye injury is indicated due to the risk of endophthalmitis.

Risk factors for post-traumatic endophthalmitis include: delayed primary repair of the injury (more than 12 hours); presence of an intraocular foreign body; injuries occurring in a rural location or contaminated with organic matter; rupture of the lens capsule; and vitreous prolapse through the wound.

Do not use topical antibiotics if an open globe injury is suspected because preservatives are toxic to the intraocular contents.

While there is no definitive evidence on the most effective pre-emptive treatment, intravitreal ceftazidime plus vancomycin may reduce infection rate in high-risk cases if they can be safely administered at the time of surgery.

It is common practice to start systemic antibiotics when a patient presents for care following a penetrating eye injury. Consider:

1 moxifloxacin 400 mg (child: 10 mg/kg up to 400 mg) orally, daily for 5 to 7 days¹ ². For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment penetrating eye injury moxifloxacin

OR

2 ciprofloxacin 750 mg (child: 20 mg/kg up to 750 mg) orally, twice daily for 5 to 7 days³ ⁴. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment. penetrating eye injury ciprofloxacin

Moxifloxacin has better intraocular penetration than ciprofloxacin; however, ciprofloxacin can be used if moxifloxacin is not available.

Following surgical repair, it is also common practice to start topical antibiotic therapy. Use:

1 ciprofloxacin 0.3% eye drops, 1 drop into the affected eye, four times a day for 7 days penetrating eye injury ciprofloxacin

OR

1 ofloxacin 0.3% eye drops, 1 drop into the affected eye, four times a day for 7 days penetrating eye injury ofloxacin

OR (if available)

1 cefazolin 5% plus gentamicin 0.9% eye drops, 1 drop into the affected eye, four times a day for 7 days penetrating eye injury cefazolin

OR (if there is a low risk of endophthalmitis)

1 chloramphenicol 0.5% eye drops, 1 drop into the affected eye, four times a day for 7 days. penetrating eye injury chloramphenicol

Topical antibiotic drops can be administered more frequently than four times a day, depending on the nature of the injury and the risk of infection.

¹ Moxifloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, there are few data from human trials to support this finding. Moxifloxacin can be used in children when it is the drug of choice.Return

² An oral liquid formulation of moxifloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see the Don’t Rush to Crush Handbook, published by the Society of Hospital Pharmacists of Australia [URL].Return

³ Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, there are few data from human trials to support this finding. Ciprofloxacin can be used in children when it is the drug of choice.Return

⁴ An oral liquid formulation of ciprofloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see the Don’t Rush to Crush Handbook, published by the Society of Hospital Pharmacists of Australia [URL].Return