Superficial infections, caused by a variety of organisms, are treated by chloramphenicol, fusidic acid, framycetin, gentamicin, ciprofloxacin, ofloxacin or neomycin in drops or ointments. Ciprofloxacin, ofloxacin, gentamicin or tobramycin are used for Pseudomonas aeruginosa, and fusidic acid principally for Staphylococcus aureus. Preparations often contain hydrocortisone or prednisolone, but the steroid masks the progress of the infection, and should it be applied with an antimicrobial to which the organism is resistant (bacterium or virus) it may make the disease worse by suppressing protective inflammation. Local chemoprophylaxis without corticosteroid is used to prevent secondary bacterial infection in viral conjunctivitis. A variety of antibiotics may be given by direct injection to the chambers of the eye for treatment of bacterial endophthalmitis.
Chlamydial conjunctivitis. In the developed world, the genital (D-K) serotypes of the organism are responsible and the reservoir and transmission is maintained by sexual contact. Endemic trachoma in developing countries is usually caused by serotypes A, B and C. In either case, oral tetracycline is effective. Pregnant or lactating women may receive systemic erythromycin. Neonatal ophthalmia should be treated with systemic erythromycin and topical tetracycline.
Herpes keratitis (see p. 258). It is essential that a corticosteroid should never be put on the eye; the disease is exacerbated and permanent blindness can result.
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