Clinical challenges of ocular anti‐microbial therapy

Abstract

AbstractPurpose To discuss the different clinical challenges in ocular anti‐microbial therapy as they pertain to bacteria, fungi, viruses, and acanthamoeba.Methods An overview of how the different infections often seen and how available medications might be utilized.Results With the large number of medications available to ophthalmologists these days, deciding what medication to use can be complicated. The initial choice of fourth‐generation fluoroquinolones has raised questions about bacterial resistance. This may highlight the importance of cultures in cases where infections are not responding as expected. Recognition of certain infections, such as early acanthamoeba, which can look similar to herpetic keratitis, may be difficult. The use of newer diagnostic tests, such as PCR, may be helpful to ensure appropriate treatment is started in a timely fashion. This may also be helpful in targeting treatment in fungal infections. The use of long term wear contact lenses, such as with a keratoprosthesis, has raised questions as to whether antibiotics are efficiently reaching the corneal surface and treating biofilms that form on contact lenses. Understanding what flora is present in cases of long term contact use may allow clinicians to better prevent infections. There have also been many clinicians who have advocated the treatment of viral conjunctivitis to help reduce the number of lost work and school hours. There is still debate as to the efficacy of these treatments and how it might impact the continually growing cost of health care.Conclusion Newer testing modalities and understanding what long term use of ocular anti‐microbials does on the ocular surface will improve our treatment of ocular infections and hopefully prevent them too.