What to Know About Antibiotic Eye Ointments

OTC and Prescription Ointment Used to Treat Eye Infection

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Whether you’re dealing with an infection, a simple stye, or some other eye issue, getting a handle on what to do about applying antibiotic ointment to the area can be tricky. These topical medications, which usually need to be squeezed out of a tube, can leave you wondering how to best get these on the surface of the eye or inner eyelid.

These eye ointments contain different types of antibiotics and are prescribed to combat a variety of infections. While they are mostly helpful, all antibiotics come with potential health risks. It’s important to keep in mind that if not used appropriately, such antibiotic infused eye ointments may cause side effects. Here’s how to best use them.

Applying eye ointment to the inside of the lower lid

buradaki / iStock / Getty Images

Uses

All antibiotics are not the same. There are different antibiotic classes with different mechanisms of action. These include aminoglycoside, macrolide, polypeptide, quinolone, and tetracycline antibiotics.

Such medications can disrupt bacteria at different points in the lifecycle. Depending on the type of bacteria, some may also be more effective in fighting these. They are ineffective against viruses, fungi, or parasites.

Types of infections that are typically treated with antibiotic creams include:

  • Blepharitis (bacterial)
  • Conjunctivitis (bacterial, viral)
  • Endophthalmitis (bacterial, fungal)
  • Keratitis (bacterial, fungal, parasitic, viral)
  • Stye (bacterial)
  • Uveitis (general viral but associated with developing secondary bacterial eye infections)

Fortunately, most bacterial infections of the eye do respond to some currently available topical antibiotics. If an eye infection is not responding to the medication, keep in mind, it could be caused by an organism that's not a bacteria.

Before Taking

If you come in complaining of a tender, red eye, you will likely be given a broad-spectrum antibiotic aimed to treat a common, uncomplicated infection.

Keep in mind that the infection may not respond to this medication. It may be necessary for the healthcare provider to perform tests to determine exactly what type of infection this is and what type of antibiotic is best suited here. These tests can also show if the infection is bacterial at all.

Be aware, there are a variety of different antibiotic eye ointments for adults, as well as children available. Some of the most commonly prescribed of these include:

  • Bacitracin: A polypeptide, brand name Baciguent
  • Ciprofloxacin: A quinolone, brand name Ciloxan
  • Erythromycin: A macrolide, brand names Eyemycin, Ilotycin, and Roymicin
  • Gentamicin: An aminoglycoside, brand names Garamycin, Genoptic, and Gentak
  • Neosporin: A triple antibiotic comprised of polymyxin, neomycin, and bacitracin
  • Polysporin: A double antibiotic comprised of polymyxin and bacitracin

While you can find some Neosporin and Polysporin ointments sold over-the-counter, these products are not for the eyes. Rather, they are only for scrapes on the skin elsewhere. Ophthalmic Neosporin and Polysporin can only be obtained with a prescription and will say "for ophthalmic use only" on the packaging.

Depending on the infection, practitioners may prescribe antibiotic drops to treat this instead of ointment. You may in some cases also be able to find some drops over-the-counter meant for mild infections. If you do, use these non-prescription drops make sure to seek medical advice right away if there is no improvement after a couple of days.

Precautions and Contraindications

Anyone who has an allergy, or is suspected of having one, to the antibiotic or another antibiotic in the same class should not take this medication. If you have had a prior allergic reaction to any antibiotic be sure to discuss this with your healthcare provider before using any antibiotic ointment.

Be aware that antibiotic use should not be taken lightly, even with eye ointments. With many practitioners commonly prescribing antibiotics to prevent infections, as well as to treat these, the concern is that with overuse organisms can adapt in way that outsmarts the drug's mechanism of action for killing them.

This may mean that some antibiotics are no longer as effective at treating certain infections, which have become resistant to them.

A 2018 study that looked at how resistance to antibiotics affected eye-related bacteria, showed that while some types of resistant bacteria decreased over a 10-year time frame, more than 50% of one type of bacteria was still resistant to the fluoroquinolone medication levofloxacin. Investigators cautioned that it's important to keep this in mind and if possible, only use this medication on a limited basis.

Leftover Antibiotics

If you happen to have leftover antibiotic ointment from an old eye infection, don't reach for this without first speaking with your healthcare provider.

It's important to make sure that it's the right medication at the right dose and that you're taking this for the correct amount of time. Otherwise, you may inadvertently treat the infection with the wrong agent, which may add to the development of resistance.

You may also expose the eye to contaminants if using medication past its expiration date. Preservatives in the medication can break down and allow contaminants to flourish. The end result is you make things worse.

Dosage

Eye ointments are prescribed for a specific period of time, to be taken every few hours. To avoid resistance, be sure to use the medication as prescribed, even if your symptoms subside. Here's how you should take the following eye ointments:

Eye Ointment Dosage Chart
Drug Age Dose
 Bacitracin Adults, adolescents, children Apply a thin film in the eye every 3 to 4 hours for 7 to 10 days.
 Ciprofloxacin Adults Apply 1/2 inch ribbon in conjunctival sac 3 times per day for first 2 days, then 1/2 inch twice daily for next 5 days.
 Erythromycin Adults, adolescents, children, infants Apply a 1 centimeter (cm) long ribbon to the affected structure of the eye up to 6 times daily, depending upon infection severity. 
 Gentamicin Adults, adolescents, children, infants (safety has not been established in neonates) Apply an approximately 1/2 inch ribbon to the affected eye(s) 2 to 3 times daily. 
 Neosporin Adults (safety and efficacy has not been established for other age groups. However, more limited use in adolescents and children over age 2 is possible.) Apply an approximately 1/2 inch strip of ointment to the affected eye(s) every 3 to 4 hours for 7 to 10 days. For children and adolescents, this can be applied 3 times a day for 7 days. 
 Polysporin Adults Apply a thin strip to the eye(s) every 3 to 4 hours for 7 to 10 days.

How to Use and Store

This antibiotic ointment should be kept closed in the container in which it came, safely out of the reach of children. Be sure to store this at a moderate room temperature, avoiding places where there may be excessive heat or moisture, such as the bathroom

When using ophthalmic antibiotic ointments apply these to the inside lower lid of the affected eye. Usually this is done every 3 to 4 hours for a week to 10 days, but, of course, follow your healthcare providers instructions.

If you do not see improvement in the first few days or if your symptoms get worse after using the ointment, be sure to check with your practitioner on this.

Keep in mind, this is for the eye only. Do not put the ointment in your nose or mouth. Also, do not share the ointment with anyone else since this can enable germs to spread from one person to another.

Side Effects

While generally safe, some may experience side effects from the antibiotic ointment. Most common side effects are not serious.

Common

Common side effects include:

  • Temporary blurring
  • Eye discharge
  • Eyelid irritation, burning, itching, swelling, or redness
  • Eye pain
  • Red or scaly patches around eye or lids

Severe

While most side effect are not too concerning, it is possible to experience anaphylaxis in some rare instances. Anaphylaxis is a potentially life-threatening allergic reaction that needs to be taken seriously and is a medical emergency requiring 911 assistance. Signs of this can include the following:

  • Chest tightness
  • Difficulty breathing or swallowing
  • Dizziness
  • Faintness
  • Hives
  • Hoarseness
  • Skin rash
  • Swelling of the face, throat, tongue, lips, eyes, hands, feet, lower legs, or ankles

Warnings and Interactions

Before using any antibiotic eye ointment, be sure to inform your healthcare provider about any other prescription medication you may be taking, as well as any over-the-counter medications or supplements, or recreational drugs that may be in your system.

While topical medications such as these usually do not cause problems, use these antibiotic ointments with caution and inform your practitioner if you have any of the following conditions:

  • Cardiac disease or arrhythmias
  • Colitis
  • Diabetes
  • Hepatic disease
  • Renal impairment
  • Thyroid disease

Also, if you are pregnant or breastfeeding, be sure to alert your healthcare provider before using these antibiotic ointments. Those who usually wear contact lenses should avoid wearing these while being treated for the infection.

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Article Sources
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