Steroid Antibiotic Eye Drop Combinations

The advantage of topical steroid and antibiotic combinations is that when decision is taken to administer such drugs combination, there is greater patient compliance and convenience with the added assurance that the appropriate dosage of both the drugs are in the same formulation, compatibility of ingredients is assured and the correct volume of drug is delivered and retained.

In antibiotic steroid topical combination, steroids provide powerful anti-inflammatory effect while the associated antibiotic provide bactericidal effect.

They are indicated in the following eye conditions;

• In the treatment of anterior segment inflammatory disorders which may be threatened with or complicated by bacterial sensitivity to antibiotics.
•  In chronic anterior uveitis and corneal injury from chemical, radiation or thermal burns.
• In pre and post-operative surgery where the possibility of infection with susceptible organisms exists.

They are contraindicated in the following conditions;

• In acute superficial herpes simplex (dendritic keratitis),vaccinia, varicella and other viral infection of the cornea and conjunctiva.
•  In fungal eye infections, ocular tuberculosis and in hypersensitive patients.
•  In ocular infections caused by microorganisms that are not sensitive to antibiotics in steroid combination. 
• Prolonged use may results in overgrowth of non-susceptible organisms.

To administer the drug, the patient is advised to instill one to two drops into the lower conjunctival sac two to four times a day. Care should be taken not discontinue the treatment prematurely and abruptly.

Examples of steroid-antibiotc combinations include the following;

• Dexamethasone with Neomycin (Idrocil).
• Dexamethasone with Framycetin (Otozone).
• Dexamethasone with Tobramycin (Tobrazone).
• Dexamethasone with Ofloxacin (Oflo DM).
• Dexamethasone with Gentamycin (Dexagent).
• Betamethasone with Neomycin (Beta-N).
• Betamethasone with Chloramphicol (Betaphenicol).
• Betamethasone with Gentamycin.
• Flurometholone with Tetracycline (Florocycline).
• Flurometholone with Neomycin.
• Flurometholone with Tobramycin.
• Flurometholone with Gentamicin.
• Prednisolone with Sulphacetamide (Sulphazone).
• Hydrocortisone with Neomycin.

The mainstay treatment for posterior segment and orbit inflammations is systemic steroids (tablets and injections). However, systemic steroids can also be used in severe inflammation of the anterior segment of the eye in addition to steroidal eye drops or ointments.

Systemic steroids are indicated in the following eye conditions;

• In posterior uveitis, retrobulbar neuritis and papillitis.
• In macular edema, orbital pseudotumor, malignant exophthalmos and scleritis.
• In systemic ophthalmia, anterior ischemic optic neuropathy, severe anterior uveitis, herpes zoster ophthalmicus, etc .

Dosage, duration and type of systemic steroids used depend upon the severity and type of ocular diseases in which it is required.

Some of the common complications of topical steroid therapy are as follows;

• Reduced body resistance to viral, bacterial and fungal infections.
• Induced posterior subcapsular cataract.
• Raised intraocular pressure in susceptible patients with optic nerve damage.
• Delayed wound healing and dry eye.
• Perforates the globe especially when the cornea and sclera are thin.
• Secondary ocular infections from fungi and virus.
• Mydriasis and ptosis.

Because of the above complications, eye care practitioners are advised to use topical NSAIDs especially in older individuals instead of topical steroids. In situations where topical steroids must be used, moderation is quite necessary and the patient should be monitored.