Kovoor TA, Kim AS, McCulley JP, et al. Evaluation of the corneal effects of topical ophthalmic fluoroquinolones using in vivo confocal microscopy. Eye Contact Lens 30: 90-94, 2004.

Moxifloxacin (Avelox). Can Adverse Reaction Newslett 12: 3, 2002. Nettis E, Giordana D, Pierluigi T, et al. Erythema multiforme-like rash in

patient sensitive to ofloxacin. Acta Derm Venereol 82: 395-396, 2002. Ophthalmic moxifloxacin (vigamox) and Gatifloxacin (zymar). Med Lett

Drugs Ther 46: 25–27, 2004.

Schwab IR, Friedlaender M, McCulley J, et al. A phase III clinical trial of 0.5% levofloxacin in ophthalmic solution versus 0.3% ofloxacin ophthalmic­ solution for the treatment of bacterial conjunctivitis.

­Ophthalmology 110: 457-465, 2003.

Silver LH, Woodside AM, Montgomery DB. Clinical safety of moxifloxacin ophthalmic solution 0.5% (Vigamox) in pediatric and nonpediatric patients with bacterial conjunctivitis. Surv Ophthalmol 50(Suppl 1): S55-S61, 2005.

Wittpenn JR. Crystallization of gatifloxacin after penetrating keratoplasty. Eye Contact Lens 31: 93, 2005.

Generic name: Gentamicin sulfate.

Proprietary names: Garamycin, Genoptic, Gentacidin, Gentak, Gentasol, Ocu-Mycin.

Primary use

This aminoglycoside is effective against Ps. aeruginosa, Aerobacter, E. coli, K. pneumoniae and Proteus.

Ocular side effects

Systemic administration

Probable

1. Decreased vision

2. Papilledema secondary to intracranial hypertension

3. Loss of eyelashes or eyebrows

4. Eyelids

a.Photosensitivity

b.Urticaria

5. Myasthenia gravis (aggravates)

a.Diplopia

b.Ptosis

c.Paresis of extraocular muscles 6. Visual hallucinations

7. Oscillopsia

Possible

1. Subconjunctival or retinal hemorrhages secondary to drug-induced anemia

Local ophthalmic use or exposure – topical application or subconjunctival injection

Certain

1. Conjunctiva

a.Hyperemia

b.Mucopurulent discharge

c.Chemosis

d.Ulceration – necrosis

e.Mild papillary hypertrophy

f.Delayed healing

g.Localized pallor

h.Pseudomembranous conjunctivitis 2. Eyelids

a.Allergic reactions

b.Blepharoconjunctivitis

c.Depigmentation

3. Cornea

a.Superficial punctate keratitis

b.Ulceration

c.Delayed healing

4. Overgrowth of nonsusceptible organisms

Probable – subconjunctival injection

1. Scleral-retinal toxicity and necrosis

2. Extraocular and periocular muscle myopathy

3. Pupil dilation

Local ophthalmic use or exposure – intravitreal or intraocular injection

Certain

1. Retina

a.Infarcts

b.Retinal edema

c.Hemorrhages

d.Opacities

e.Pigmentary changes

f.Degeneration

2. Vitreous opacities

3. Optic nerve changes including atrophy

a.Retinal edema

b.Occlusion

c.Hemorrhages

d.Ischemia

Clinical significance

Surprisingly few drug-induced ocular side effects from systemic administration of gentamicin have been reported. Intracranial hypertension with secondary papilledema and visual loss following systemic use of gentamicin are the most clinically significant. Other adverse ocular effects are reversible and transitory after discontinued use of the drug. Marra et al (1988) described two cases of self-limiting oscillopsia, probably secondary to gentamicin­ -induced ototoxicity.

Topical ocular gentamicin may cause significant local side ­effects, the most common being a superficial punctate keratitis. Chronic use can also cause keratinization of the lid margin and blepharitis. Skin depigmentation in blacks, primarily when topical ocular gentamicin was associated with eye pad use, has been reported. Conjunctival necrosis, especially with fortified solutions, may occur. This usually is found in the inferior nasal conjunctiva, and starts as a localized area of hyperemia or pallor that usually stains with fluorescein. The lesions start after 5–7 days on either gentamicin solution or ointment and resolve after discontinuing the drug within 2 weeks. Bullard and O’Day (1997) reported four cases of pseudomembranous conjunctivitis after topical ocular gentamicin. These also occurred inferiorly and started with an intense focal bulbar conjunctival hyperemia, mucopurulent discharge and palpebral conjunctival papillae. The membranes appeared 4–7 days after starting therapy and resolved 4–5 days after the drug was stopped. Libert et al (1979) and D’Amico and Kenyon (1981) described lamellated cytoplasmic storage inclusion containing lipid material in the conjunctiva secondary to gentamicin injections. Awan (1985) described paresthesia of the eyes from topical ocular gentamicin and pupillary dilation from subconjunctival injections. Chapman et al (1992) showed that subconjunctival injections of gentamicin could cause muscle fiber degeneration with myopathy causing ocular motility impairment.

nfectivesi -Anti ectiS • 1on