Chloramphenicol Ophthalmic Preparations: An Overview of Eye Drops and Ointments

Eye infections are one of the most common reasons patients visit an ophthalmologist or a drugstore in India and other countries. These diseases include conjunctivitis, bacterial endophthalmitis, and bacterial keratitis; they are not only a source of discomfort, but also compromise productivity in addition to bringing on complications if they go unnoticed.

There are numerous antibiotics to treat ocular infections. Still, chloramphenicol eye drops and an ointment are one of the most popular ocular antibiotics due to their wide antimicrobial action, low cost, and high efficacy.

This article helps you understand more about chloramphenicol eye ointment and its different preparations with corticosteroids, with or without polymyxin B and dexamethasone.

We will also discuss its mechanism of action, uses, administration methods, safety profile, and storage factors for the patient and medical workers.

To understand the significance of chloramphenicol, it is necessary to have some idea about how this drug works. Chloramphenicol is a broad-spectrum antibiotic that acts by binding with the 50S subunit of bacterial ribosomes. This blocks peptide-bond formation in the process of protein synthesis, disabling bacterial growth and allowing the host's immunity to clear the infection.

Its activity spectrum encompasses Gram-positive and Gram-negative organisms, including Haemophilus influenzae and Streptococcus Pneumoniae, which are the common infectious agents of bacterial conjunctivitis. Chloramphenicol ointment is an effective topical treatment of surface and deeper infections because of its ability to penetrate ocular tissues.

The uses of chloramphenicol eye ointment and drops include:

• Bacterial conjunctivitis: One of the most common eye infections, presenting with redness, sticky discharge, and irritation.
• Blepharitis: Inflammation of the eyelid margins, where bacteria often colonise.
• Superficial keratitis: When the cornea becomes inflamed due to bacterial infection.
• Prophylaxis in minor ocular injuries or post-surgical procedures: Reducing the risk of bacterial contamination.

While chloramphenicol cream is typically used for skin infections, chloramphenicol ointment is a common ophthalmic formulation. The ointment is often preferred for nighttime use because its semi-solid base allows it to remain on the eye surface for a longer period. In contrast, chloramphenicol drops are more convenient and can be administered easily at any time of day.

Chloramphenicol eye drops and ointment offer key advantages of cost-effectiveness, expansive coverage, and high efficacy against most of the common ocular pathogens, making it accessible to patients.

In other instances, physicians administer a combination product of antibiotics and corticosteroids. Examples include:

• Chloramphenicol with hydrocortisone acetate eye ointment: This combination reduces bacterial load while addressing inflammation and swelling.
• Chloramphenicol and dexamethasone eye drops (also referred to as dexamethasone chloramphenicol eye drops or chloramphenicol with dexamethasone eye drops): These are commonly prescribed for infections with associated inflammation, such as post-operative irritation or severe conjunctivitis.
• Chloramphenicol hydrocortisone acetate eye ointment: Effective in controlling itching and redness along with bacterial involvement.

The thought process behind such combinations is that the combination of antibiotics and corticosteroids can remove bacteria and decrease the immune-mediated inflammation, which offers quick relief of symptoms.

They, however, have to be applied under close medical supervision as extended steroid application can raise the intraocular pressure or predispose it to secondary infections.

Correct administration of chloramphenicol eye drops and ointment is crucial; if not, it can diminish its efficacy. Here’s a quick guide on how to use chloramphenicol eye ointment and drops:

For Eye Drops:

• Wash your hands thoroughly.
• Tilt the head back and gently pull down the lower eyelid.
• Hold the dropper close to the eye, but do not touch the surface.
• Allow one drop into the conjunctival sac (space between your eye and lower lid).
• Close the eye gently for one to two minutes, avoiding blinking.
• Wipe excess liquid with a clean tissue.

For Eye Ointment:

• Wash your hands before application.
• Squeeze about 1 cm of chloramphenicol ointment for the eyes into the lower eyelid.
• Avoid touching the tube tip to the eye or eyelashes.
• Close the eye gently and roll it around to spread the medication evenly.
• Wipe excess ointment with a clean tissue.

Chloramphenicol and Polymyxin B Sulphate Ophthalmic Ointment: Enhanced Infection Control

An additional effective mixture is chloramphenicol polymyxin B sulphate ophthalmic ointment since it has a more extensive antibacterial coverage. Polymyxin B is noted to be quite effective against Gram-negative organisms such as Pseudomonas Aeruginosa, a common producer of corneal ulcers and severe infections of the eye.

This ointment, when used in conjunction with chloramphenicol, has a broad spectrum that covers Gram-positive and Gram-negative bacteria; therefore, it is highly useful in resistant and mixed infections.

Such combination therapy is usually done under hospital or specialist care, where there is an increased bacterial resistance pattern dictating more aggressive treatment.

While effective, chloramphenicol ointment and drops carry certain safety concerns. Common side effects include:

• Mild burning or stinging upon application.
• Blurred vision immediately after ointment use.
• Allergic reactions such as itching, swelling, or redness.

A rather serious complication related to the systemic usage of chloramphenicol is the suppression of the bone marrow, resulting in aplastic anaemia. Though this is a rare idiosyncratic risk associated with topical ophthalmic use, you should be careful and let your doctor know if you notice any side effects.

Storage and Handling Tips for Chloramphenicol Eye Drops and Ointments

Proper handling minimised the risk of contamination, which can aggravate the infection. To preserve effectiveness, here’s how you can store chloramphenicol eye drops and ointment:

• Keep in a cool, dry place away from direct sunlight.
• Refrigeration is recommended for certain formulations, but always check the packaging instructions.
• Do not freeze eye drops.
• Discard opened bottles of drops after four weeks to avoid contamination.
• Always check the expiry date before use.
• Tighten the tube, especially if using chloramphenicol ointment.

Q. What are the uses of chloramphenicol eye drops and ointment?

A. Chloramphenicol eye drops and ointment are prescribed to treat bacterial conjunctivitis and other eye infections. They work by stopping bacterial growth, reducing redness, swelling, irritation, and discomfort. These medications are typically recommended for short-term use under medical supervision.

Q. How does chloramphenicol work to treat eye infections?

A. Chloramphenicol treats eye infections by blocking bacterial protein synthesis, which prevents bacteria from multiplying. This action helps the body’s immune system eliminate the infection, thereby reducing symptoms like redness, swelling, itching, and discharge associated with bacterial eye conditions.

Q. When is chloramphenicol ointment for the eyes prescribed?

A. Chloramphenicol eye ointment is prescribed for bacterial conjunctivitis and other eye surface infections, especially where prolonged contact with the eye is required. Doctors may recommend it for children, elderly patients, or individuals needing overnight treatment for effective infection control.

Q. How do I apply chloramphenicol eye ointment correctly?

A. To apply chloramphenicol eye ointment, wash your hands, gently pull down the lower eyelid, and squeeze about 1 cm of the ointment into your eye. Close your eyes briefly, avoid touching the tip to your eye, and follow dosage instructions carefully.

Q. What is the difference between chloramphenicol eye drops and eye ointment?

A. Chloramphenicol eye drops act quickly and are convenient for daytime use, but require frequent application. Eye ointment stays longer in the eye, providing sustained effect, though it may blur vision temporarily, making it better suited for nighttime use.

Q. What is chloramphenicol with hydrocortisone acetate eye ointment used for?

A. Chloramphenicol with hydrocortisone acetate eye ointment combines an antibiotic and a corticosteroid. It is prescribed to treat bacterial eye infections with associated inflammation, helping reduce redness, swelling, irritation, and pain while simultaneously targeting the underlying bacterial cause.

Q. What are chloramphenicol and dexamethasone eye drops used for?

A. Chloramphenicol and dexamethasone eye drops combine antibiotic and anti-inflammatory properties. They are prescribed for bacterial eye infections accompanied by inflammation, swelling, or allergic reactions, helping relieve symptoms while preventing bacterial growth. Usage should follow strict medical guidance.