Corneal deposits and topical ofloxacin-the effect of polypharmacy in the management of microbial keratitis.

Mitra A, Tsesmetzoglou E, McElvanney A.

1Department of Ophthalmology, Epsom and St Helier University Hospitals NHS Trust, Sutton Hospital, Sutton, UK.

PurposeTo report six cases of corneal deposits after administration of topical ofloxacin in the treatment of bacterial keratitis.Method/resultSix cases of microbial keratitis treated with multiple topical medications, including topical ofloxacin, resulted in corneal precipitates and poor wound healing. In five cases, the precipitates resolved with discontinuation of ofloxacin treatment. However, in one patient, some residual deposits persisted following discontinuation of ofloxacin. The cornea epithelialised, but deposits were identified subepithelially.DiscussionFluoroquinolone antibiotic drops have been extensively used in bacterial keratitis because of their ease of availability, broad spectrum of activity, and lack of toxicity. While corneal precipitates have been reported with cases of topical ciprofloxacin and norfloxacin, little has been documented on corneal deposits and topical ofloxacin in the treatment of bacterial keratitis. The predisposing factors resulting in corneal deposits and the role of polypharmacy are important features that may impair epithelialisation. Clinical management should be aimed at reducing the toxic environment and promoting ocular surface stability.Eye advance online publication, 17 March 2006; doi:10.1038/sj.eye.6702303.