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==Conjunctivitis==
*Mild bacterial conjunctivitis is usually self-limited, and it typically resolves spontaneously without specific treatment in immune-competent adults (except for methicillin-resistant staphylococcal conjunctivitis, gonococcal conjunctivitis, and conjunctivitis due to C. trachomatis)
*Severe bacterial conjunctivitis requires antimicrobial therapy and is characterized by copious purulent discharge, pain, and marked inflammation of the eye.
*Systemic antibiotic therapy is necessary to treat conjunctivitis due to Neisseria gonorrhoeae and Chlamydia trachomatis
*Methicillin-resistant Staphylococcal infections should be treated with topical antibiotics.
*Topical and/or oral antiviral therapy is recommended for HSV conjunctivitis to prevent corneal infection
*Neither topical nor oral antiviral treatment is recommended to treat either adenoviral or VZV conjunctivitis. Empiric topical antibiotics may be administered to prevent secondary bacterial infection
===Conjunctivitis===
===Conjunctivitis===
 
* Conjunctivitis, infectious<ref>{{Cite journal| last1 = Quinn| first1 = Christopher J.| last2 = Mathews| first2 = Dennis E.| title = Optometric clinical practice guideline care of the patient with conjunctivitis| journal = | date = Nov 8 2002| pmid = | pmc = }}</ref><ref>{{Cite journal| last1 = McLeod| first1 = Stephen D.| last2 = Feder| first2 = Robert S.| title = Conjunctivitis: Preferred Practice Pattern - American Academy of Ophthalmology| journal = | date = 2013|}}</ref>
* Conjunctivitis, acute<ref>{{Cite journal| doi = 10.1001/jama.2013.280318| issn = 1538-3598| volume = 310| issue = 16| pages = 1721–1729| last1 = Azari| first1 = Amir A.| last2 = Barney| first2 = Neal P.| title = Conjunctivitis: a systematic review of diagnosis and treatment| journal = JAMA| date = 2013-10-23| pmid = 24150468| pmc = PMC4049531}}</ref>
:*Infectious conjunctivitis
 
::*'''1. Causative pathogens'''
:* Bacterial conjunctivitis
:::*Neisseria gonorrhoeae
::* Empiric antimicrobial therapy
:::*Neisseria meningitidis
:::* Preferred regimen (1): [[Gentamicin]] ointment qid for 1 week {{or}} [[Gentamicin]] solution 1-2 drops qid for 1 week {{or}} [[Tobramycin]] ointment tid for 1 week
:::*Chlamydia trachomatis
:::* Preferred regimen (2): [[Besifloxacin]] solution 1 drop 3 times for 1 week {{or}} [[Ciprofloxacin]] ointment tid for 1 week {{or}} [[Ciprofloxacin]] solution 1-2 drops topical qid for 1 week {{or}} [[Gatifloxacin]] solution tid for 1 week {{or}} [[Levofloxacin]] solution 1-2 drops qid for 1 week {{or}} [[Moxifloxacin]] solution tid for 1 week {{or}} [[Ofloxacin]] solution 1-2 drops qid for 1 week
:::*Staphylococcus aureus
:::* Preferred regimen (3): [[Azithromycin]] ointment bid for 2 days, then 1 drop qd for 5 days {{or}} [[Erythromycin]] ointment qid for 1 week
:::*Staphylococcus epidermidis
:::* Preferred regimen (4): [[Sulfacetamide]] ointment qid and at bedtime for 1 week {{or}} [[Sulfacetamide]] solution 1-2 drops q2-3h for 1 week
:::*Streptococcus pneumoniae
:::* Preferred regimen (5): [[Trimethoprim]]/[[Polymyxin B]] solution 1 or 2 drops qid for 1 week
:::*Streptococcus haemolyticus
:::: Note: Topical steroids are not recommended for bacterial conjunctivitis.
:::*Haemophilus influenzae
 
:::*Moraxella spp.
:* Pathogen-directed antimicrobial therapy
:::*Proteus mirabilis
::* '''Chlamydia trachomatis'''
:::*Escherichia coli
:::* Inclusion conjunctivitis
:::*Pseudomonas aeruginosa
::::* Preferred regimen: [[Azithromycin]] 1 g PO qd
:::*Adenovirus
::::* Alternative regimen: [[Doxycycline]] 100 mg PO bid for 7 days
:::*Herpes simplex virus
:::* Conjunctivitis secondary to trachoma
:::*Herpes zoster virus
::::* Preferred regimen: [[Azithromycin]] 20 mg/kg PO for one single dose
::*'''2. Conjunctivitis, neonatal prophylaxis'''
::::* Alternative regimen (1): [[Tetracycline]] {{or}} [[Erythromycin]] ointment for 6 weeks
:::*Preferred regimen (1): 0.5% [[Erythromycin]] ophthalmic ointment, single dose
::::* Alternative regimen (2): [[Tetracycline]] PO for 3 weeks {{or}} [[Erythromycin]] PO for 3 weeks
:::*Alternative regimen: 2.5% [[|Providone|Providone-iodine]] solution ophthalmic ointment, single dose
 
::*'''3. Empiric antimicrobial therapy'''
::* '''Neisseria gonorrhoeae'''
:::*Preferred regimen (1): [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week
:::*Preferred regimen (2): [[Bacitracin|Bacitracin zinc]] 500U/g ophthalmic ointment qhs to qid for 1 week
:::*Preferred regimen (3): [[Chloramphenicol]] 1.0% ophthalmic ointment q2h to qid for 1 week {{or}} [[Chloramphenicol]] 0.5% solution q2h to qid for 1 week
:::*Preferred regimen (4): [[Erythromycin]] 0.5% ophthalmic ointment qhs to qid for 1 week {{or}} [[Azithromycin]] 1% ophthalmic ointment bid for 2 days then qd for 5 days
:::*Preferred regimen (5): [[Ciprofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Ofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Levofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Moxifloxacin]] 0.5% ophthalmic ointment bid to tid for 1 week {{or}} [[Besifloxacin]] 0.6% ophthalmic suspension tid for 1 week {{or}} [[Gatifloxacin]] 0.5% ophthalmic solution tid for 1 week
:::*Preferred regimen (6): [[Polymyxin B]]/[[Trimethoprim|Trimethoprim sulfate]] 10,000 U, 1 mg/mL ophthalmic solution q3h for 1 week
:::*Preferred regimen (7): [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week
:::*Preferred regimen (8): [[Sulfacetamide|Sodium sulfacetamide]] 10%-30% ophthalmic solution q2hr to qid for 1 week
:::*Preferred regimen (9): [[Sulfisoxazole|Sulfisoxazole diolamine]] 4.0% ophthalmic solution qid for 1 week
:::*Preferred regimen (10): [[Tetracycline]] 1.0% ophthalmic ointment q2h to qid for 1 week
:::*Note (1): All regimens have similar efficacy.
:::*Note (2): When empiric antimicrobial therapy is administered, the patient's age, environment, and related ocular findings may guide the treatment of choice.
:::*Note (3): Some regimens are associated with transient blurring of vision.
:::*Note (4): Topical steroids are not recommended for bacterial conjunctivitis.
:* '''4. Pathogen-directed antimicrobial therapy'''
::* '''4.1 Chlamydia trachomatis'''
:::* Preferred regimen (1): [[Azithromycin]] 1 g PO, single dose
:::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 7 days
:::* Pediatric regimen (1): Children who weigh < 45 kg: [[Erythromycin]] solution 50 mg/kg/day PO qid for 2 weeks  {{or}} [[Ethylsuccinate]] 50 mg/kg/day PO qid for 2 weeks
:::* Pediatric regimen (2): Chidren who weigh ≥ 45 kg but are aged < 8 years: [[Azithromycin]] 1 g PO, single dose
:::* Pediatric regimen (3): Children ≥ 8 years: [[Azithromycin]] solution 1 g PO, single dose {{or}} Doxycycline 100 mg PO bid for 1 week
:::* Neonatal regimen: Erythromycin 50 mg/kg/day PO qid for 2 weeks {{or}} [[Ethylsuccinate]] 50 mg/kg/day PO qid for 2 weeks
:::*Note (1): Neonates administered [[Erythromycin]] should be followed for signs and symptoms of infantile hypertrophic pyloric stenosis
:::*Note (2): Sexual contacts of patients with C. trachomatis conjunctivitis should be treated at the same time
::* '''4.2 Neisseria gonorrhoeae'''
:::* Hyperacute bacterial conjunctivitis, adult
:::* Hyperacute bacterial conjunctivitis, adult
::::* Preferred regimen: [[Ceftriaxone]] 1 g IM once
::::* Preferred regimen: [[Ceftriaxone]] 25 mg IM, single-dose {{and}} ([[Azithromycin]] 1 g PO, single dose {{or}} [[Doxycycline]] 100 mg PO bid for 1 week)
::::: Note: Dual therapy to cover Chlamydia is indicated.
::::*Alternative regimen, cephalosporin-allergic: [[Azithromycin]] 2 g PO, single dose
 
::::*Pediatric dose: Children who weigh < 45 kg: [[Ceftriaxone]] 125 mg IM, single dose {{or}} [[Spectinomycin]] 40 mg/kg (maximum dose 2 g) IM, single dose
::* '''Staphylococcus aureus, methicillin-resistant (MRSA)'''
::::*Neonatal dose: [[Ceftriaxone]] 25-50 mg/kg (maximum dose 125 mg) IV or IM, single dose
:::* Preferred regimen: [[Vancomycin]] ointment 1% qid
::::*Note (1): The regimen provides adequate coverage for both N. gonorrhea and C. trachomatis
 
::::*Note (2): Children who weigh > 45 kg are administered adult doses for the management of N. gonorrhoeae conjunctivitis
::* Herpetic conjunctivitis
::::*Note (3): Neisseria meningitidis must be ruled out as a causative organism before concluding that Neisseria gonorroeae is responsible
:::* '''Herpes simplex virus'''
::::*Note (4): Patients diagnosed with gonococcal conjunctivitis should be seen daily until resolution of conjunctivitis. Interval history, visual acuity measurement, and slit-lamp biomicroscopy should be performed daily.
::::* Preferred regimen: [[Acyclovir]] 1 drop topical 9 times per day {{or}} [[Acyclovir]] 400 mg PO 5 times per day for 7-10 days {{or}} [[Valacyclovir]] 500 mg PO tid for 7-10 days
::* '''4.3 Staphylococcus aureus'''
::::: Note: Topical steroids should be avoided.
:::*'''4.3.1 Methicillin-sensitive Staphylococcus aureus (MSSA)'''
 
::::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Bacitracin|Bacitracin zinc]] 500U/g ophthalmic ointment qhs to qid for 1 week {{or}} [[Chloramphenicol]] 1.0% ophthalmic ointment q2h to qid for 1 week {{or}} [[Chloramphenicol]] 0.5% solution q2h to qid for 1 week {{or}} [[Erythromycin]] 0.5% ophthalmic ointment qhs to qid for 1 week {{or}} [[Azithromycin]] 1% ophthalmic ointment bid for 2 days then qd for 5 days {{or}} [[Ciprofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Ofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Levofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Moxifloxacin]] 0.5% ophthalmic ointment bid to tid for 1 week {{or}} [[Besifloxacin]] 0.6% ophthalmic suspension tid for 1 week {{or}} [[Gatifloxacin]] 0.5% ophthalmic solution tid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week {{or}} [[Tetracycline]] 1.0% ophthalmic ointment q2h to qid for 1 week
:::* '''Varicella zoster virus'''
:::*'''4.3.2 Methicillin-resistant Staphylococcus aureus (MRSA)'''
::::* Preferred regimen: [[Acyclovir]] 800 mg PO 5 times per day for 7-10 days {{or}} [[Famciclovir]] 500 mg PO tid for 7-10 days {{or}} [[Valacyclovir]] 1000 mg PO tid for 7-10 days
::::* Preferred regimen: [[Vancomycin]] 1% ophthalmic ointment qid for 2 weeks
::::: Note: Treatment usually consists of a combination of oral antivirals and topical steroids.
:::*'''4.3.3 Methicillin-sensitive Staphylococcus epidermidis (MSSE)'''
 
::::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Bacitracin|Bacitracin zinc]] 500U/g ophthalmic ointment qhs to qid for 1 week {{or}} [[Chloramphenicol]] 1.0% ophthalmic ointment q2h to qid for 1 week {{or}} [[Chloramphenicol]] 0.5% solution q2h to qid for 1 week {{or}} [[Erythromycin]] 0.5% ophthalmic ointment qhs to qid for 1 week {{or}} [[Azithromycin]] 1% ophthalmic ointment bid for 2 days then qd for 5 days {{or}} [[Ciprofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Ofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Levofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Moxifloxacin]] 0.5% ophthalmic ointment bid to tid for 1 week {{or}} [[Besifloxacin]] 0.6% ophthalmic suspension tid for 1 week {{or}} [[Gatifloxacin]] 0.5% ophthalmic solution tid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week {{or}} [[Tetracycline]] 1.0% ophthalmic ointment q2h to qid for 1 week
----
:::*'''4.3.4 Methicillin-resistant Staphylococcus aureus (MRSE)'''
::::* Preferred regimen: [[Vancomycin]] 1% ophthalmic ointment qid for 2 weeks
::*'''4.4 Streptococcus species'''
:::*'''4.4.1 Streptococcus pnuemoniae'''
::::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Bacitracin|Bacitracin zinc]] 500U/g ophthalmic ointment qhs to qid for 1 week {{or}} [[Erythromycin]] 0.5% ophthalmic ointment qhs to qid for 1 week {{or}} [[Azithromycin]] 1% ophthalmic ointment bid for 2 days then qd for 5 days {{or}} [[Ciprofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Ofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Levofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Moxifloxacin]] 0.5% ophthalmic ointment bid to tid for 1 week {{or}} [[Besifloxacin]] 0.6% ophthalmic suspension tid for 1 week {{or}} [[Gatifloxacin]] 0.5% ophthalmic solution tid for 1 week {{or}} [[Polymyxin B]]/[[Trimethoprim|Trimethoprim sulfate]] 10,000 U, 1 mg/mL ophthalmic solution q3h for 1 week {{or}} [[Sulfacetamide|Sodium sulfacetamide]] 10%-30% ophthalmic solution q2hr to qid for 1 week {{or}} [[Sulfisoxazole|Sulfisoxazole diolamine]] 4.0% ophthalmic solution qid for 1 week
:::*'''4.4.2 Streptococcus haemolyticus'''
::::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Bacitracin|Bacitracin zinc]] 500U/g ophthalmic ointment qhs to qid for 1 week {{or}} [[Erythromycin]] 0.5% ophthalmic ointment qhs to qid for 1 week {{or}} [[Azithromycin]] 1% ophthalmic ointment bid for 2 days then qd for 5 days {{or}} [[Ciprofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Ofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Levofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Moxifloxacin]] 0.5% ophthalmic ointment bid to tid for 1 week {{or}} [[Besifloxacin]] 0.6% ophthalmic suspension tid for 1 week {{or}} [[Gatifloxacin]] 0.5% ophthalmic solution tid for 1 week {{or}} [[Polymyxin B]]/[[Trimethoprim|Trimethoprim sulfate]] 10,000 U, 1 mg/mL ophthalmic solution q3h for 1 week {{or}} [[Sulfacetamide|Sodium sulfacetamide]] 10%-30% ophthalmic solution q2hr to qid for 1 week {{or}} [[Sulfisoxazole|Sulfisoxazole diolamine]] 4.0% ophthalmic solution qid for 1 week
::*'''4.5 Haemophilus influenzae'''
:::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Chloramphenicol]] 1.0% ophthalmic ointment q2h to qid for 1 week {{or}} [[Chloramphenicol]] 0.5% solution q2h to qid for 1 week {{or}} [[Erythromycin]] 0.5% ophthalmic ointment qhs to qid for 1 week {{or}} [[Azithromycin]] 1% ophthalmic ointment bid for 2 days then qd for 5 days {{or}} [[Ciprofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Ofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Levofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Moxifloxacin]] 0.5% ophthalmic ointment bid to tid for 1 week {{or}} [[Besifloxacin]] 0.6% ophthalmic suspension tid for 1 week {{or}} [[Gatifloxacin]] 0.5% ophthalmic solution tid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week {{or}} [[Sulfacetamide|Sodium sulfacetamide]] 10%-30% ophthalmic solution q2hr to qid for 1 week {{or}} [[Sulfisoxazole|Sulfisoxazole diolamine]] 4.0% ophthalmic solution qid for 1 week
::*'''4.6 Moraxella spp.'''
:::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week {{or}} [[Sulfacetamide|Sodium sulfacetamide]] 10%-30% ophthalmic solution q2hr to qid for 1 week {{or}} [[Sulfisoxazole|Sulfisoxazole diolamine]] 4.0% ophthalmic solution qid for 1 week
::*'''4.7 Proteus mirabilis'''
:::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week
::*'''4.8 Escherichia coli'''
:::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week {{or}} [[Tetracycline]] 1.0% ophthalmic ointment q2h to qid for 1 week
::*'''4.9 Pseudomonas aeruginosa'''
:::*Preferred regimen: [[Gentamicin]]/[[Tobramycin]] 0.3% ophthalmic ointment q2h to qid for 1 week {{or}} [[Ciprofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Ofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Levofloxacin]] 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week {{or}} [[Moxifloxacin]] 0.5% ophthalmic ointment bid to tid for 1 week {{or}} [[Besifloxacin]] 0.6% ophthalmic suspension tid for 1 week {{or}} [[Gatifloxacin]] 0.5% ophthalmic solution tid for 1 week {{or}} [[Polymyxin B]]/[[Neomycin]] 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week
::*'''4.10 Herpes Simplex Virus'''
:::*Preferred regimen: [[Ganciclovir]] 0.15% ophthlamic gel qid for 1 week
:::*Alternative regimen (1): [[Trifluridine]] 1% solution q4h for 1 week
:::*Alternative regimen (2): [[Acyclovir]] 200 mg to 400 mg PO q5h per day for 1 week
:::*Alternative regimen (3): [[Valacyclovir]] 500 mg PO tid for 1 week
:::*Alternative regimen (4): [[Famciclovir]] 250 mg PO bid for 1 week
:::*Note: Corticosteroids should be avoided.
::*'''4.11 Varicella Zoster Virus'''
:::*Preferred regimen: [[Acyclovir]] 800 mg PO q5hr for 1 week
:::*Alternative regimen (1): [[Valacyclovir]] 1000 mg PO q8h for 1 week
:::*Alternative regimen (2): [[Famciclovir]] 500 mg PO tid for 1 week


==Blepharitis==
*Blepharitis is a chronic condition that may not be fully cured. It often requires chronic care and follow-up
*Warm compresses, eyelid cleansing, and eyelid massage twice daily are recommended in the management of infectious blepharitis
*Topical antimicrobial therapy may be prescribed, but there is insufficient evidence to confirm their efficacy in the management of blepharitis
*In patients with chronic blepharitis that does not respond to therapy, the possibility of carcinoma should be considered, particularly if associated with a loss of eyelashes
*[[Isotretinoin]] used to treat cystic acne is associated with significant increase in colonization of conjunctiva with Staphylococcus aureus blepharitis and disruption of tear function. Discontinuation of isotretinoin leads to improvement in many cases.
===Blepharitis===
===Blepharitis===
*Blepharitis, infectious<ref>{{Cite journal| last1 = McLeod| first1 = Stephen D.| last2 = Chang| first2 = David F.| title = Blepharitis: Preferred Practice Pattern - American Academy of Ophthalmology| journal = | date = 2013|}}</ref>
:*Infectious blepharitis
::*'''1. Causative pathogens'''
:::*Staphylococcus aureus
:::*Coagulase-negative Staphylococcus spp.
:::*Demodex folliculorum
:::*Streptococcus pyogenes
:::*Herpes simplex virus
:::*Varicella zoster virus
:::*Papillomavirus
:::*Vaccinia
:::*Molluscum contagiosum
::*'''2. Empiric antimicrobial therapy'''<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref>
:::*'''Blepharitis'''
::::*Preferred regimen: [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days
::::*Alternative regimen (1): [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks
::::*Alternative regimen (2): [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks
::::*Alternative regimen (3): [[Erythromycin]]ophthalmic ointment qhs for 2 weeks
::::*Alternative regimen (4): [[Metronidazole]] 2% gel bid for 1-2 weeks
::::*Note: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months may be helpful in some cases of posterior blepharitis
::*'''3. Specific considerations'''
:::*'''3.1 Meibomian gland dysfunction''':
::::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks.
::::*Alternative regimen (1): [[Erythromycin]] 250-500 mg PO qd for 3 weeks {{or}} [[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{or}} [[Azithromycin]] 1 g PO once per week for 3 weeks
::::*Note: [[Tetracyclines]] are contraindicated among pregnant women, nursing women, and young children < 8 years of age
:::*'''3.2 Dry eye'''
::::*Preferred regimen: [[Cyclosporine]] 0.05% ophthalmic emulsion bid for 6 months
:::*'''3.3 Ocular Rosacea'''
::::*Preferred regimen: [[Doxycycline]] 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks {{or}} [[Minocycline]] 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks {{or}} [[Tetracycline]] 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks {{or}} ([[Azithromycin]] 250-500 mg PO 1-3 times a week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks) {{or}} ([[Azithromycin]] 1 g PO once per week for 3 weeks {{and}} [[Tacrolimus]] 0.1% topical bid for 3 weeks)
::*'''4. Pathogen-directed antimicrobial therapy'''
:::*'''4.1 Staphylococcus spp.'''
::::*Preferred regimen: [[Bacitracin]] ophthalmic ointment qhs for 2 weeks {{or}} [[Bacitracin]]/[[Polymyxin B Sulfate]] ophthalmic ointment bid to qid for 2 weeks {{or}} [[Erythromycin]]ophthalmic ointment qhs for 2 weeks {{or}} [[Azithromycin]] 1% ophthalmic solution bid for 2 days followed by qd for 12-26 days {{or}} [[Tobramycin]]/[[Dexamethasone]] 0.3%/0.05% ophthalmic suspension qid for 2 weeks
:::*'''4.2 Demodex folliculorum'''
::::*Preferred regimen: [[Metronidazole]] 2% gel bid for 1-2 weeks
::::*Alternative regimen: [[Ivermectin]] 200 microgram/kg once weekly for 2 weeks


:*'''Empiric therapy'''<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref>
==Endophthalmitis==
::*'''Blepharitis'''
*Endogenous endophthalmitis is caused by the hematologic dissemination of an infection to the eyes. Systemic antibiotics are recommended in endogenous bacterial endophthalmitis because the source of the infection is distant from the eye.
:::*Preferred regimen: [[Bacitracin]] {{or}} [[Erythromycin]] topical/systemic once or more times daily or at bedtime for a few weeks {{and}} topical anti-inflammatory drugs such as [[Corticosteroids]], [[Cyclosporine]]
*Most common extraocular foci of infection include liver abscess, pneumonia, endocarditis, and soft tissue infection.
:::*Alternative regimen: [[Metronidazole]] gel {{or}} [[Tobramycin]]/[[Dexamethasone]] ophthalmic suspension {{or}} [[Azithromycin]] sustained release system.
*Bacterial and fungal cultures from vitreous samples are necessary in the management of endophthalmitis
:::: Note (1): Cure is usually not possible with blepharitis. Eyelid hygiene may provide symptomatic relief for both anterior and posterior blepharitis.
*Immediate vitrectomy is often necessary
:::: Note (2): [[Cyclosporine]] topical drops 0.05% may be helpful in some patients with posterior blepharitis.
===Endophthalmitis===
 
*Endophthalmitis, infectious<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
:*'''Specific considerations'''
:*'''1. Causative pathogens'''
::*'''Meibomian gland dysfunction''':
::*Staphylococcus epidermidis
:::*Preferred regimen: ([[Doxycycline]] 100 mg qd {{or}} [[Minocycline]] 100 mg qd {{or}} [[Tetracycline]] 1000 mg in divided doses), tapered to ([[Doxycycline]] 40-50 mg qd {{or}} [[Minocycline]] 40-50 mg qd {{or}} [[Tetracycline]] 250-500 mg qd) after clinical improvement is noted (ususally 2-6 weeks)
::*Staphylococcus aureus
:::*Alternative regimen: [[Erythromycin]] 250-500 mg PO qd {{or}} [[Azithromycin]] 250-500 mg 1-3 times a week or 1 g per week for 3 weeks
::*Streptococci
::::Note (1): [[Tetracyclines]] are contraindicated in pregnancy, nursing women and those with history of hypersenstivity to tetracycline.
::*Enterococci
::::Note (2): Patients with contact-lens-associated giant papillary conjunctivitis have an increased frequency of meibomian gland dysfunction.
::*Bacillus spp.
::*'''Dry eye'''
::*Escherichia coli
:::*Preferred regimen: [[Cyclosporine]] topical and [[Omega-3 fatty acids]] two 1000 mg capsules tid
::*Neisseria meningitidis
::*'''Dermatological conditions with seborrheic blepharitis and meibomian gland dysfunction'''
::*Klebsiella spp.
:::*Preferred regimen: [[Azithromycin]] oral with [[Tacrolimus]] 0.1% topical
::*Propionibacterium spp.
:::*Alternative regimen: [[Tetracycline]] oral
::*Corynebacterium spp.
::::Note: In some patients [[Azithromycin]] oral may lead to abnormalities in electrical activity of heart with the potential to create serious irregularities in heart rhythm.
::*Pseudomonas aeruginosa
::*'''Demodicosis'''
::*Candida spp.
:::Preferred regimen: [[Metronidazole]] gel to eyelid skin
::*Aspergillus spp.
:::Alternative regimen: [[Ivermectin]] oral in recalcitrant Demodex bleharitis
::*Fusarium spp.
::*'''Ocular Rosacea'''
:* '''2. Empiric antimicrobial therapy'''
:::*Preferred regimen: [[Tetracyclines]] topical
::* Preferred regimen: [[Vancomycin]] 1 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Vancomycin]] 1 g IV bid for 2 weeks {{and}} [[Ceftazidime]] 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Ceftazidime]] 1 g IV bid for 2 weeks {{and}} [[Clindamycin]] 600-1200 mg IV bid to qid for 2 weeks
::::Note (1): In patients with chronic blepharitis that does not respond to therapy, the possibility of carcinoma should be considered, particularly if associated with a loss of eyelashes.
::* Note (1): Re-injection should be considered if the infection does not improve beyond 48 hours of the first injection. Re-injection significantly increases the risk of retinal toxicity.
::::Note (2): [[Isotretinoin]] used to treat cystic acne is associated with significant increase in colonization of conjunctiva with Staphylococcus aureus blepharitis and disruption of tear function. Discontinuation of isotretinoin leads to improvement in most cases.
::* Note (2): In addition to intravitreal and systemic antibiotic therapy, vitrectomy is usually necessary
 
::* Note (3): Intravitreal and intravenous [[Amphotericin B]] may be added to the regimen if fungal endophthalmitis is suspected
===Endophthalmitis, bacterial===
:*'''3. Pathogen-directed antimicrobial therapy'''
::*'''3.1 Bacillus spp.'''
:::*Preferred regimen: [[Vancomycin]] 1 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Vancomycin]] 1 g IV bid for 2 weeks {{and}} [[Clindamycin]] 600-1200 mg IV bid to qid for 2 weeks
:::* Note: In addition to antimicrobial therapy, vitrectomy is usually necessary
::*'''3.2 Non-Bacillus gram-positive bacteria'''
:::*Preferred regimen: [[Vancomycin]] 1 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Vancomycin]] 1 g IV bid for 2 weeks
:::* Note: In addition to antimicrobial therapy, vitrectomy is usually necessary
::*'''3.3 Gram-negative bacteria'''
:::*Preferred regimen: [[Ceftazidime]] 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Ceftazidime]] 1 g IV bid for 2 weeks
:::* Note: In addition to antimicrobial therapy, vitrectomy is usually necessary
::*'''3.4 Candida spp.'''
:::*Preferred regimen: ([[Fluconazole]] 400-800 mg IV/PO qd for 6-12 weeks {{or}} [[Voriconazole]] 400 mg IV/PO bid for 2 doses followed by 200-300 mg IV/PO bid for 6-12 weeks {{or}} [[Amphotericin B]] 0.7-1.0 mg/kg IV qd for 6-12 weeks) {{and}} [[Amphotericin B]] 5-10 microgram in 0.1 mL in normal saline intravitreal injection, single dose
:::* Note (1): In addition to antimicrobial therapy, vitrectomy is usually necessary
::*'''3.5 Aspergillus spp.'''
:::*Preferred regimen: [[Amphotericin B]] 5-10 microgram in 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Dexamethasone]] 400 microgram intravitreal injection, single dose
:::* Note (1): In addition to antimicrobial therapy, vitrectomy is usually necessary
:::* Note (2): Repeat antimicrobial regimen in 2 days post-vitrectomy
:*'''4. Special Considerations'''
::*'''4.1 Endogenous endophthalmitis'''
:::* '''4.1.1 Empiric antimicrobial therapy'''
::::* Preferred regimen: [[Vancomycin]] 1 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Vancomycin]] 1 g IV bid for 2 weeks {{and}} [[Ceftazidime]] 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Ceftazidime]] 1 g IV bid for 2 weeks {{and}} [[Clindamycin]] 600-1200 mg IV bid to qid for 2 weeks
::::* Note (1): Re-injection should be considered if the infection does not improve beyond 48 hours of the first injection. Re-injection significantly increases the risk of retinal toxicity.
::::* Note (2): In addition to intravitreal and systemic antibiotic therapy, vitrectomy is usually necessary::* Note (3): Intravitreal and intravenous [[Amphotericin B]] may be added to the regimen if fungal endophthalmitis is suspected
::*'''4.2 Bleb-related endophthalmitis'''
:::* '''4.2.1 Empiric antimicrobial therapy'''
::::* Preferred regimen: [[Vancomycin]] 1 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Vancomycin]] 1 g IV bid for 2 weeks {{and}} [[Ceftazidime]] 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Ceftazidime]] 1 g IV bid for 2 weeks {{and}} [[Clindamycin]] 600-1200 mg IV bid to qid for 2 weeks
::::* Note (1): Re-injection should be considered if the infection does not improve beyond 48 hours of the first injection. Re-injection significantly increases the risk of retinal toxicity.
::::* Note (2): In addition to intravitreal and systemic antibiotic therapy, vitrectomy is usually necessary
::*'''4.3 Post-operative endophthalmitis'''
:::*'''4.3.1 Empiric antimicrobial therapy'''
::::* Preferred regimen: [[Vancomycin]] 1 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Ceftazidime]] 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose
::::*Note (1): In addition to intravitreal antibiotic therapy, vitrectomy is necessary
::::*Note (2): If there is no improvement in 48 h, a repeat intravitreal injection may be administered
::::*Note (3): Late post-operative endophthalmitis is often caused by Propionibacterium acnes (several years post-op)
:::*'''4.3.2 Pathogen-directed antimicrobial therapy'''
::::*'''4.3.2.1 Gram-positive bacteria'''
:::::* Preferred regimen: [[Vancomycin]] 1 mg per 0.1 mL normal saline intravitreal injection, single dose
::::*'''4.3.2.2 Gram-negative bacteria'''
:::::* Preferred regimen: [[Amikacin]] 0.4 mg per 0.1 mL normal saline intravitreal injection, single dose
:::::* Note: Intravitreal amikacin is associated with the development of retinal microvasculitis
::*'''4.4 Post-traumatic endophthalmitis'''
:::*'''4.4.1 Empiric antimicrobial therapy'''
::::*Preferred regimen: [[Vancomycin]] 1 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Ceftazidime]] 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose {{and}} [[Amphotericin B]] 5-10 microgram in 0.1 mL in normal saline intravitreal injection, single dose
::::*Note (1): Removal of foreign bodies and debridement of necrotic tissue is necessary
::::*Note (2): In addition to antimicrobial therapy, vitrectomy is necessary
::::*Note (3): Systemic broad spectrum antibiotics are recommended in post-traumatic endophthalmitis


* Endogenous bacterial endophthalmitis
==Keratitis==
:* '''Empiric antimicrobial therapy'''<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
*Microbial keratitis should be managed as bacterial keratitis until proven otherwise.
::* Preferred regimen (intravitreal): [[Vancomycin]] 1 mg/0.1 mL normal saline {{and}} ([[Ceftazidime]] 2.25 mg/0.1 mL {{or}} [[Amikacin]] 0.4 mg/0.1 mL)
*Steroids are indicated in the management of keratitis to reduce inflammation that may damage the eye.
::* Preferred regimen (intravenous): antibiotic active against underlying source of bacteremia
::: Note (1): In conjunction with intravitreal and systemic antibiotic therapy, a vitrectomy is necessary in nearly all cases.
::: Note (2): Intravitreal antibiotics are given at the end of a vitrectomy case in the operating room, or as an office procedure without a vitrectomy.
::: Note (3): Endogenous bacterial endophthalmitis arises from bacteremic seeding associated with endocarditis, urinary tract infections, indwelling central venous catheters, illicit injection drug use, procedures (e.g., endoscopy), or liver abscess. Common pathogens include Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus milleri group, group A and B streptococci, and Gram-negative bacilli (e.g., Escherichia coli, Klebsiella pneumoniae).


===Endophthalmitis, bleb-related===
*Keratitis, infectious<ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/bacterial-keratitis-ppp--2013#references/ | title == bacterial keratitis ppp 2013}}</ref>
:* '''Empiric antimicrobial therapy'''<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
::* Preferred regimen (intravitreal): [[Vancomycin]] 1 mg/0.1 mL normal saline {{and}} [[Ceftazidime]] 2.25 mg/0.1 mL
::: Note (1): In conjunction with intravitreal antibiotic therapy, a vitrectomy is necessary in most cases.
::: Note (2): Intravitreal antibiotics are given at the end of a vitrectomy case in the operating room, or as an office procedure without a vitrectomy.
::: Note (3): It is reasonable to give an oral quinolone, such as [[Moxifloxacin]], that achieves good vitreous levels and treats the major pathogens.


===Endophthalmitis, candidal===
:*Bacterial keratitis
::*'''1. Causative pathogens'''
:::*Pseudomonas aeruginosa
:::*Staphylococcus epidermidis
:::*Staphylococcus aureus
:::*Streptococcus pneumoniae
:::*Serratia spp.
:::*Hemophilus spp.
:::*Moraxella spp.
:::*Neisseria gonorrhea
:::*Corynebacterium diphtheriae
:::*Listeria spp.
:::*Shigella spp.
:::*Nocardia spp.
:::*Mycobacterium spp.


* Endogenous candida endophthalmitis<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
::*'''2. Empiric antimicrobial therapy'''
:*'''Empiric therapy'''' <ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
::*Preferred regimen (intravitreal): [[Amphotericin]] intravitreal {{or}} [[Voriconazole]] intravitreal.
::*Preferred regimen (intravenous): [[Fluconazole]] (if suspectable) {{or}} [[Voriconazole]]  {{or}} [[Amphotericin]]
:::Note (1): In conjunction with intravitreal and systemic antibiotic therapy, a vitrectomy is necessary if viritis (endophthalmitis) is present.
:::Note (2): often there is a need to remove artificial intra-ocular lense.
:::Note (3) : Systemic antibiotics alone are not effective in treating endophthalmitis, except for most cases of Candida chorioretinitis without vitritis. They are indicated in endogenous endophthalmitis and fungal endophthalmitis. Whether they are beneficial as adjunctive therapy in exogenous bacterial endophthalmitis is unknown.


* Exogenous candida endophthalmitis
:::*Preferred regimen (1): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
:*'''Empiric therapy'''
::*Preferred regimen (intraocular) : [[Amphotericin]] is 5-10 mcg in 0.1 mL of sterile water intravitreal  {{or}} [[Voriconazole]]  is usually 100 mcg in 0.1 mL of sterile water intravitreal.
::*Preferred regimen (intravenous) :  High-dose [[Fluconazole]] (400-800 mg qd assuming the normal kidney function)  is also indicated for susceptible strains, {{or}} [[Voriconazole]] for fluconazole-resistant but voriconazole-susceptible strains.
:::Note (1): Candida parapsilosis is the most common species, especially in postsurgical outbreaks.
:::Note (2): if infection follows cataract surgery, it is often necessary to remove the intra ocular lense as well.


===Endophthalmitis, chronic===
:::*Preferred regimen (2): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks


===Endophthalmitis, mold===
:::*Preferred regimen (3): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks
* Exogenous mould endophthalmitis
:::*Preferred regimen (4): [[Moxifloxacin]] 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
*'''Empiric therapy''' <ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
:* Preferred regimen (intravitreal and intracameral): [[Amphotericin]] {{or}} [[Voriconazole]] intravitreal  and intracameral injections
:* Preferred regimen (intravenous): [[Voriconazole]]
:: Note (1) :  Unless the fungus is known, the initial intra-ocular injection should be amphotericin; subsequent injections may be voriconazole for sensitive fungi. Repeated intra-ocular injections of voriconazole (if the organism is susceptible) or amphotericin can be given, at least 48 hours apart.
:: Note (2) : In conjunction with intravitreal and systemic antibiotic therapy, a vitrectomy is necessary in nearly all cases.
:: Note (3) : Artificial intra-ocular lense needed to be removed.
* Endogenous mould endophthalmitis
*'''Empiric therapy'''
:* Preferred therapy (intravitreal) : Amphotericin intravitreal or voriconazole intravitreal
:* Preferred regimen (intravenous): In immunocompromised patients, treatment must include systemic antifungal therapy
:: Note (1): if the patient is able to tolerate surgery , vitrectomy and removal of any IOL, followed by intravitreal amphotericin or voriconazole should be performed.
:: Note (2): If too ill for surgery, the patient should have intravitreal injection of amphotericin or voriconazole, with repeated injections as needed.
:: Note (3): In injection drug users with no evidence of ongoing fungaemia, vitrectomy, intravitreal anti-fungal injection and systemic therapy should be given.


===Endophthalmitis, post-cataract  surgery, acute===
:::*Preferred regimen (5): [[Gatifloxacin]] 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:*Empiric therapy <ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
::* Preferred regimen (intravitreal):[[Vancomycin]] 1 mg/0.1 mL normal saline intravitreal {{and}} [[Ceftazidime]] 2.25 mg/0.1 mL intravitreal
::* Preferred regimen (intravenous): rarely given
:::Note (1) : In conjunction with intravitreal antibiotic therapy, a vitrectomy is necessary  if severe infection or fungal etiology
:::Note (2) : If there is no improvement in 48 h, a repeat intravitreal injection may be given with either vancomycin or ceftazidime, depending on culture  results.
:::Note (3) : Repeated injections of amikacin are avoided, owing to concerns about retinal toxicity.
:::Note (4): No need to remove intra-ocular lense, unless fungal etiology.


===Endophthalmitis, post-cataract surgery, chronic===
:::*Preferred regimen (6): [[Cefazolin]] 5% q30min to q1h on day 1 then q2h on day 2 then q4h on days 3-14 {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14 {{or}} [[Gentamicin]] 1.5% ophthalmic ointment q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14)


:*'''Empiric therapy'''<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
:::*Alternative regimen (1), unresponsive keratitis: [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 {{and}} [[Amikacin]] 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*Preferred regimen (intravitreal): [[Vancomycin]] 1 mg/0.1 mL normal saline intravitreal 
:::Note (1) : Artificial intra-ocular lense needed to be removed.
:::Note (2) : Most common pathogen causing post-cataract endophthalmitis is  Propionibacterium acnes.
:::Note (3) : Necessity for vitrectomy is varied.


===Endophthalmitis, post-tramatic===
:::*Alternative regimen (2): [[Erythromycin]] 0.5% ophthalmic ointment qhs for 1 week {{and}} ([[Amikacin]] 5% {{and}}/{{or}} [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14)
:*'''Empiric therapy'''<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=PMC3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028  }} </ref>
::*Preferred regimen (intravitreal): [[Vancomycin]] 1 mg/0.1 mL normal saline intravitreal {{and}} [[Ceftazidime]] 2.25 mg/0.1 mL intravitreal ( {{ and}} [[Amphotericin]] intravitreal if fungi suspected)
:::Note : intravitreal antibiotics are given at the end of a vitrectomy case in the operating room, or as an office procedure without a vitrectomy.
::*Preferred regimen (intravenous):Intravenous [[Vancomycin]] {{and}} ([[Ceftazidime]] {{or}} [[Ciprofloxacin]])
:::Note (1): Systemic antibiotics alone are not effective in treating endophthalmitis, except for most cases of Candida chorioretinitis without vitritis. They are indicated in endogenous endophthalmitis and fungal endophthalmitis. Whether they are beneficial as adjunctive therapy in exogenous bacterial endophthalmitis is unknown.
:::Note (2):  In conjunction with intravitreal antibiotic therapy and intravenous antibiotic therapy , a vitrectomy is necessary in most cases.
:::Note (3): Need to remove artificial intra-ocular lens varies (always if fungal).
:::Note (4) : Treatment should be aggressive, with vitrectomy, intravitreal antibiotics (e.g. vancomycin plus ceftazidime), and systemic therapy.
:::Note (5) : Most common pathogens are Bacillus cereus, coagulase-negative staphylococci (fungi in some cases).


===Keratitis, bacterial===
:::* Note (1) : Subconjunctival antibiotics may be helpful where there is imminent scleral spread or perforation or in cases where adherence to the treatment regimen is questionable.
:*'''Empiric therapy'''<ref>{{cite web / url = http: // http://www.aao.org/preferred-practice-pattern/bacterial-keratitis-ppp--2013#references/ title == bacterial keratitis ppp 2013}}</ref>
:::* Note (2) : Systemic therapy is necessary for suspected gonococcal infection.


::*'''No organism identified (or) multiple types of organisms'''
::*'''3. Pathogen-directed antimicrobial therapy'''
:::*Preferred regimen (topical) : [[Cefazolin]] 50 mg/ml with [[Tobramycin]]/[[Gentamycin]] 9-14 mg/ml {{or}} ( fluoroquinolones-[[Besifloxacin]] 6 mg/ml, [[Ciprofloxacin]] 3 mg/ml, [[Levofloxacin]] 15 mg/ml, [[Moxifloxacin]] 5 mg/ml, [[Ofloxacin]] 3 mg/ml ) {{and}}
:::*Preferred regimen (subconjunctial):  [[Cefazolin]] 100 mg in 0.5 ml with [[Tobramycin]]/[[Gentamycin]] 20 mg in 0.5 ml.
::::Note (1) : Topical antibiotic eye drops are capable of achieving high tissue levels and are the preferred method of treatment in most cases.
::::Note (2) : Subconjunctival antibiotics may be helpful where there is imminent scleral spread or perforation or in cases where adherence to the treatment regimen is questionable.
::::Note (3) : Systemic therapy is necessary for suspected gonococcal infection.
:::*Adjunctive therapy: ocular ointments may be useful at bedtime in less severe cases.


:*'''Organism specific bacterial keratitis
:::*'''3.1 Non-streptococcal gram-positive bacteria'''


::*'''Gram positive cocci'''
::::*Preferred regimen (1): [[Moxifloxacin]] 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:::*Preferred regimen (topical): [[Cefazolin]] 50 mg/ml {{or}} [[Vancomycin]] 15-50 mg/ml {{or}} [[Bacitracin]] 10,000 IU topical concentration  {{or}} fluoroquinolones-[[Besifloxacin]] 6 mg/ml {{or}} ( [[Ciprofloxacin]] 3 mg/ml {{or}} [[Levofloxacin]] 15 mg/ml {{or}} [[Moxifloxacin]] 5 mg/ml {{or}} [[Ofloxacin]] 3 mg/ml ) {{and}}
::::*Preferred regimen (2): [[Gatifloxacin]] 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:::*Preferred regimen (subconjunctival): [[Cefazolin]] 100 mg in 0.5 ml {{or}} [[Vancomycin]] 25 mg in 0.5 ml
::::Note: Vancomycin and gentamycin have no gram negative activity and should not be used as a single agent in empirically treating bacterial keratitis.


::*'''Gram negative bacilli'''
::::*Preferred regimen (3): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
:::*Preferred regimen (topical): [[Tobramycin]]/[[Gentamycin]] 9-14 mg/ml {{or}} [[Ceftazidime]] 50 mg/ml {{or}} fluoroquinolones-[[Besifloxacin]] 6 mg/ml, {{or}} ( [[Ciprofloxacin]] 3 mg/ml {{or}} [[Levofloxacin]] 15 mg/ml {{or}} [[Moxifloxacin]] 5 mg/ml {{or}} [[Ofloxacin]] 3 mg/ml ) {{and}}
::::*Preferred regimen (4): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
:::*Preferred regimen (subconjunctival) :[ [Tobramycin]]/[[Gentamycin]] 20 mg in 0.5 ml {{or}} [[Ceftazidime]] 100mg in 0.5 ml
::::*Preferred regimen (5): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks
::::*Preferred regimen (6): [[Cefazolin]] 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14 {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14
:::*'''3.2 Streptococcus pneumoniae'''
::::*Preferred regimen (1): [[Moxifloxacin]] 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::::*Preferred regimen (2): [[Gatifloxacin]] 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::::*Preferred regimen (3): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
::::*Preferred regimen (4): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
::::*Preferred regimen (5): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks
::::*Preferred regimen (6): [[Cefazolin]] 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14  {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14
::::Alternative regimen, unresponsive keratitis: [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 {{and}} [[Amikacin]] 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::*'''3.3 Nocardia spp.'''


::*'''Gram negative cocci'''
::::*Preferred regimen (1): [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 {{and}} [[Amikacin]] 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:::*Preferred regimen (topical):[[Ceftriaxone]] 50 mg/ml {{or}} [[Ceftazidime]] 50 mg/ml {{or}} fluoroquinolones-[[Besifloxacin]] 6 mg/ml {{or}} ([[Ciprofloxacin]] 3 mg/ml {{or}} [[Levofloxacin]] 15 mg/ml {{or}} [[Moxifloxacin]] 5 mg/ml {{or}} [[Ofloxacin]] 3 mg/ml) {{and}}
::::*Preferred regimen (2): [[Erythromycin]] 0.5% ophthalmic ointment qhs for 1 week {{and}} ([[Amikacin]] 5% {{and}}/{{or}} [[Vancomycin]] 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14)
:::*Preferred regimen (subconjunctival): [[Ceftriaxone]] 50 mg/ml {{or}} [[Ceftazidime]] 100mg in 0.5 ml


::*'''Nontuberculous mycobacteria'''
:::*'''3.3 Gram-negative bacteria'''
:::*Preferred regimen (topical): [[Amikacin]] 20-40 mg/ml {{or}} [[Clarithromycin]] 10 mg/ml {{or}} [[Azithromycin]] 10 mg/ml {{or}} fluoroquinolones-[[Besifloxacin]] 6 mg/ml {{or}} ( [[Ciprofloxacin]] 3 mg/ml {{or}} [[Levofloxacin]] 15 mg/ml {{or}} [[Moxifloxacin]] 5 mg/ml {{or}} [[Ofloxacin]] 3 mg/ml )  {{and}}
::::*Preferred regimen (1): [[Moxifloxacin]] 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
:::*Preferred regimen (subconjunctival): [[Amikacin]] 20 mg in 0.5 ml
::::*Preferred regimen (2): [[Gatifloxacin]] 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
::::*Preferred regimen (3): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
::::*Preferred regimen (4): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
::::*Preferred regimen (5): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks
::::*Preferred regimen (6): [[Cefazolin]] 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14  {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14


::*'''Nocardia'''
:::*'''3.4 Anaerobes'''
:::*Preferred regimen (topical) : [[Sulfacetamide]] 100 mg/ml {{or}} [[Amikacin]] 20-40 mg/ml {{or}} [[Trimethoprim]]/[[Sulfamethoxazole]]: Trimethoprim 16 mg/ml, Sulfamethoxazole 80 mg/ml {{and}}
:::*Preferred regimen (subconjuctival) : [[Amikacin]] 20 mg in 0.5 ml


::*Note (1) : Topical antibiotic eye drops are capable of achieving high tissue levels and are the preferred method of treatment in most cases.
::::*Preferred regimen (1): [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
::*Note (2) : Subconjunctival antibiotics may be helpful where there is imminent scleral spread or perforation or in cases where adherence to the treatment regimen is questionable.
::::*Preferred regimen (2): [[Ofloxacin]] 0.3% ophthalmic ointment q2h for 2-3 weeks
::::*Preferred regimen (3): [[Levofloxacin]] 1.5% ophthalmic ointment q2h for 2-3 weeks
<br>
:*Fungal (mycotic) keratitis<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref>
::*1. Causative pathogens
:::*Candida spp.
:::*Fusarium spp.
:::*Aspergillus spp.
:::*Curvularia spp.
::*'''2. Empiric antimicrobial therapy'''
:::* Preferred regimen (1): [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks
:::* Preferred regimen (2): [[Fluconazole]] 1% ophthalmic suspension q1h for 2-3 weeks
:::* Preferred regimen (3): [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks {{and}} [[Fluconazole]] 1% ophthalmic suspension q1h for 2-3 weeks
:::* Alternative regimen (1), unresponsive: [[Amphotericin B]] 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks
:::*Alternative regimen (2), unresponsive: [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks {{and}} [[Amphotericin B]] 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks
::*'''3. Special considerations'''
:::*Immunocompromised status, spreading ulcer, impending perforation, true perforation
::::*Preferred regimen (1): [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks {{and}} [[Fluconazole]] 1% ophthalmic suspension q1h for 2-3 weeks {{and}} ([[Ketoconazole]] IV 200-400 mg q12h for 2-3 weeks {{or}} [[Fluconazole]] IV 200 mg q12h for 2-3 weeks
::::*Preferred regimen (2): [[Natamycin]] 5% ophthalmic suspension q30min to q1h for 2-3 weeks {{and}} [[Amphotericin B]] 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks {{and}} ([[Ketoconazole]] IV 200-400 mg q12h for 2-3 weeks {{or}} [[Fluconazole]] IV 200 mg q12h for 2-3 weeks
::::*Note: Bacterial superinfection must be treated using [[Ciprofloxacin]] 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14 {{or}} ([[Cefazolin]] 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14  {{and}} [[Tobramycin]] 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14)
<br>
:*Protozoal keratitis<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref><ref name="pmid19660733">{{cite journal| author=Dart JK, Saw VP, Kilvington S| title=Acanthamoeba keratitis: diagnosis and treatment update 2009. | journal=Am J Ophthalmol | year= 2009 | volume= 148 | issue= 4 | pages= 487-499.e2 | pmid=19660733 | doi=10.1016/j.ajo.2009.06.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19660733  }} </ref>
::*'''1. Causative pathogens'''
:::*Acanthamoeba spp.
:::*Microsporidia spp.
::* '''2. Empiric antimicrobial therapy'''
:::* Preferred regimen (1): [[Polyhexamethylene biguanide]] 0.02% ophthalmic ointment q1h for 1-2 weeks {{and}} [[Chlorhexidine]] 0.02% ophthalmic ointment q1h for 1-2 weeks {{and}}/{{or}} ([[Propamidine]] 0.1% ophthalmic ointment q1h for 1-2 weeks {{or}} [[Hexamidine]] 0.1% ophthalmic ointment q1h for 2 days then q1h for another 3 days)
:::* Preferred regimen (2): [[Propamidine]] 0.1% ophthalmic ointment q1h for 1-2 weeks {{and}} [[Polyhexamethylene biguanide]] 0.02% ophthalmic ointment q1h for 1-2 weeks


===Keratitis, fungal===
:::* Preferred regimen (4): [[Propamidine]] ophthalmic ointment q1h for 1-2 weeks {{and}} [[Chlorhexidine]] ophthalmic ointment q1h for 1-2 weeks
:::* Preferred regimen (4): [[Polyhexamethylene biguanide]] 0.02% ophthalmic ointment q1h for 1-2 weeks {{and}} [[Hexamidine]] 0.1% ophthalmic ointment q1h for 2 days then q1h for another 3 days
<br>
:*Viral keratitis<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref>
::*'''1. Causative pathogens'''


:*'''Empiric therapy'''<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref>
:::*Herpes simplex virus (HSV)
::*(1) Topical antifungals
::*'''2. Empiric antimicrobial therapy'''
:::*(a) For filamentous fungi
::::(i) 1st line : 5% [[Natamycin]]
::::(ii) 2nd line : 1% [[Itraconazole]]
:::*(b)For candida
::::(i) 1st line : 0.15% [[Amphotericin B]]
::::(ii) 2nd line : [[Fluconazole]]


::* (2) Oral antifungals
:::*Preferred regimen (1): [[Acyclovir]] 3% ophthalmic ointment q5h for 2-3 weeks {{and}} [[Homatropine]] 2% ophthalmic solution bid for 2-3 weeks
:::(i) [[Ketoconazole]] 200 mg bid
:::*Preferred regimen (2): [[Idoxuridine]] 0.1% ophthalmic solution q1h in daytime and 0.5% ophthalmic ointment qhs for 1 week then 0.1% ophthalmic solution q2h in daytime and 0.5% ophthalmic ointment qhs for 2-3 weeks {{and}} [[Homatropine]] 2% ophthalmic solution bid for 2-3 weeks
:::(ii) [[Itraconazole]] 200mg qd
:::(iii) [[Fluconazole]] 50-100 mg qd


::* (3) Recently topical and oral [[Variconazole]]
==Ocular syphilis==
*'''1. Pathogen-directed antimicrobial therapy'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
:* Preferred regimen (1): [[Penicillin]] 4 MU IV q4h for 10-14 days {{and}} [[Benzathine penicillin]] 2.4 MU IM once weekly for 3 weeks
:* Note (1): [[Corticosteroids]] (Prednisone 60-80 mg PO qd) are co-administered to decrease intra-ocular inflammation and prevent rebound inflammation from Jarisch Herxheimer reaction.
:* Note (2): All patients with presumed ocular syphilis should be tested for HIV, and all should have a lumbar puncture before starting therapy to exclude concurrent neurosyphilis.


===Keratitis, protozoal===
==Ocular toxocariasis==
:*'''Empiric therapy'''<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref> , <ref name="pmid19660733">{{cite journal| author=Dart JK, Saw VP, Kilvington S| title=Acanthamoeba keratitis: diagnosis and treatment update 2009. | journal=Am J Ophthalmol | year= 2009 | volume= 148 | issue= 4 | pages= 487-499.e2 | pmid=19660733 | doi=10.1016/j.ajo.2009.06.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19660733 }} </ref>
* '''1. Pathogen-directed antimicrobial therapy'''<ref name="pmid12692098">{{cite journal| author=Despommier D| title=Toxocariasis: clinical aspects, epidemiology, medical ecology, and molecular aspects. | journal=Clin Microbiol Rev | year= 2003 | volume= 16 | issue= 2 | pages= 265-72 | pmid=12692098 | doi= | pmc=PMC153144 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12692098 }} </ref>
::*For Acanthamoeba
:* Preferred regimen: [[Albendazole]] 400 mg PO bid for 5 days
:::(i) [[Biguanide]] - (polyhexamethylene biguanide [PHMB] 0.02% or [[chlorhexidine]] 0.02%) and
:* Alternative regimen: [[Mebendazole]] 1 g PO qd for 3 weeks
:::(ii) diamidine - ([[propamidine]] 0.1% or [[hexamidine]] 0.1%)
:* Note (1): Co-administration of [[corticosteroids]] is helpful for suppressing the intense allergic manifestations of the infection.
:::*Recommended
:* Note (2): Ocular larval migrans is treated by surgery (vitrectomy) and antihelminthic chemotherapy with or without [[corticosteroids]].
::::propamidine 0.1% + polyhexamethylene biguanide 0.02% {{or}} propamidine + chlorhexidine.
::::polyhexamethylene biguanide 0.02% {{and}} hexamidine drops  are administered every hour day, and night, for 48 hours initially, followed by hourly drops by day only for a further 72 hours.
::::note (1) : Intensive early treatment is given because organisms may be more susceptible before cysts have fully matured. Epithelial toxicity is common if the dosage is maintained at this intensity.
::::Note (2) : the diamidines and biguanides are currently the most effective cysticidal antiamoebics in vitro .
::::*Toxicity of Biguanides and Diamidines : Cataract, iris atrophy,and peripheral ulcerative keratitis are all complications of Acanthamoeba keratitis that have been attributed to the use of topical biguanides and/or diamidines.
::*For microsporidia
::: (i) debridement
::: (ii) broad-spectrum antibiotics {{or}} polyhexamethylene biguanide [PHMB] {{or}} chlorhexidine.


:*'''Treatment for Limbitis and Scleritis''':
==Ocular toxoplasmosis==
:::*Oral [[NSAIDS]] treatment, such as furbiprofen 50 to 100 mg, bid or tid. If it does not respond to flurbiprofen, then high-dose systemic steroid therapy [[prednisolone]] 1 mg/kg/day), with systemic [[Cyclosporine]] (3 to 7.5 mg/kg/day), can be used for successful control.
*'''1. Pathogen-directed antimicrobial therapy'''<ref name="pmid15194258">{{cite journal| author=Montoya JG, Liesenfeld O| title=Toxoplasmosis. | journal=Lancet | year= 2004 | volume= 363 | issue= 9425 | pages= 1965-76 | pmid=15194258 | doi=10.1016/S0140-6736(04)16412-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15194258  }} </ref>
:* Preferred regimen: [[Pyrimethamine]] 200 mg PO qd on day 1 then 50-75 mg PO qd for 2 weeks beyond resolution of symptoms {{and}} [[Sulfadiazine]] 1-1.5 g PO qid for 2 weeks beyond resolution of symptoms {{and}} [[Leucovorin]] ([[Folinic acid]]) 5-20 mg PO 3 times/week for 3 weeks beyond resolution of symptoms


===Keratitis, viral===
==Ocular tuberculosis==
:*'''Empiric therapy'''<ref name="pmid17496570">{{cite journal| author=Thomas PA, Geraldine P| title=Infectious keratitis. | journal=Curr Opin Infect Dis | year= 2007 | volume= 20 | issue= 2 | pages= 129-41 | pmid=17496570 | doi=10.1097/QCO.0b013e328017f878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17496570  }} </ref>
* '''1. Pathogen-directed antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1164/rccm.167.4.603| issn = 1073-449X| volume = 167| issue = 4| pages = 603–662| last1 = Blumberg| first1 = Henry M.| last2 = Burman| first2 = William J.| last3 = Chaisson| first3 = Richard E.| last4 = Daley| first4 = Charles L.| last5 = Etkind| first5 = Sue C.| last6 = Friedman| first6 = Lloyd N.| last7 = Fujiwara| first7 = Paula| last8 = Grzemska| first8 = Malgosia| last9 = Hopewell| first9 = Philip C.| last10 = Iseman| first10 = Michael D.| last11 = Jasmer| first11 = Robert M.| last12 = Koppaka| first12 = Venkatarama| last13 = Menzies| first13 = Richard I.| last14 = O'Brien| first14 = Richard J.| last15 = Reves| first15 = Randall R.| last16 = Reichman| first16 = Lee B.| last17 = Simone| first17 = Patricia M.| last18 = Starke| first18 = Jeffrey R.| last19 = Vernon| first19 = Andrew A.| last20 = American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society| title = American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis| journal = American Journal of Respiratory and Critical Care Medicine| date = 2003-02-15| pmid = 12588714}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
::*''' (a) HSV keratitis'''
:* 1. '''Adult patients'''
:::* (1) For epithelial disease:
::* 1.1 '''Intensive phase'''
::::(i) [[Acyclovir]] 3% ointment 5 times a day (is able to penetrate intact corneal epithelium)
:::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) PO qd for 2 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) PO qd for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) PO qd for 2 months {{and}} [[Ethambutol]] 15-20 mg/kg (max: 1 g) PO qd for 2 months
::::(ii) [[Idoxuridine]] 0.1% drops now seldom used toxicity
::* 1.2 '''Continuation phase'''
::::(iii) Debridement in dendritic ulcer
:::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) PO qd for 4 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) PO qd for 4 months
:::* (2) For necrotizing stromal disease:
:* 2. '''Pediatric patients'''
:::: Oral [[Acyclovir]] {{and}} topical corticosteroids.
::* 2.1 '''Intensive phase'''
:::* (3) For nonnecrotizing stromal disease
:::* Preferred regimen: [[Isoniazid]] 10-15 mg/kg (max: 300 mg) PO qd for 2 months {{and}} [[Rifampin]] 10-20 mg/kg (max: 600 mg) PO qd for 2 months {{and}} [[Pyrazinamide]] 15-30 mg/kg (max: 2 g) PO qd for 2 months {{and}} [[Ethambutol]]
:::: Topical corticosteroids when lesion involves visual axis.Possibly oral acyclovir (debatable)
::* 2.2 '''Continuation phase'''
:::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) PO qd for 4 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) PO qd for 4 months
:* Note (1): [[Ethambutol]] may be administered at a dose of 15-20 mg/kg (max: 1 g) PO qd for 2 months but is generally avoided because of potential ocular toxicity.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
:* Note (2): A short course of systemic corticosteroids may be necessary initially if there is sight-threatening inflammation.


===Ocular syphilis===
==Orbital cellulitis==
:*'''Empiric therapy'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
*'''1. Causative pathogens'''
::* Preferred regimen (1) : [[Penicillin]] intravenous (4 million units every 4 hours,assuming normal renal function) for 10 to 14 days. Intravenous penicillin with injections of 2.4 million units of intra muscular benzathine penicillin, once weekly for 3 weeks.
:*Methicillin-sensitive staphylococcus aureus
::* Preferred regimen (2) : Systemic corticosteroids (e.g., oral [[Prednisone]] , 60 to 80 mg qd ) should be started along with the antibiotic therapy and then tapered over days to weeks.
:*Methicillin-resistant staphylococcus aureus
:: Note (1) : Corticosteroids are given to decrease intra-ocular inflammation and prevent rebound inflammation from Jarisch Herxheimer reaction.
:*Staphylococcus epidermidis
:: Note (2) : All patients with presumed ocular syphilis should be tested for HIV, and all should have a lumbar puncture before starting therapy to exclude concurrent neurosyphilis.
:*Streptococcus spp.
:: Note (3) : If there is evidence of neurosyphilis, antibiotic treatment is the same, but a follow-up lumbar puncture at 6 months is necessary to document resolution of infection.
:*Moraxella spp.
:*Anaerobes
*'''2. Empiric antimicrobial therapy'''
:*Preferred regimen (1): [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h for 1 week
:*Preferred regimen (2): [[Ceftriaxone]] 1-2 g IV q12h for 1 week
:*Preferred regimen (3): [[Clindamycin]] 300 mg IV q6h for 1 week
:* Preferred regimen (4): [[Nafcillin]] 2 g IV q4h for 1 week  {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week  {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided in 3 doses for 1 week
:* Alternative regimen (1), MRSA suspicion: [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week
:* Alternative regimen (2), MRSA suspicion: [[Vancomycin]]  1 g IV q12h for 1 week {{and}} [[Levofloxacin]] 750 mg IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week
:*Alternative regimen (3), pediatric: [[Ampicillin]]/[[Sulbactam]] 200-300 mg/kg/d IV divided q6h for 1 week
:*Alternative regimen (4), pediatric: [[Ceftriaxone]] 100 mg/kg/d IV divided q12h for 1 week
:*Alternative regimen (5), pediatric: [[Clindamycin]] 20-40 mg/kg/d IV divided q12 for 1 week
:*Note (1): Oral antibiotic therapy may be extended beyond 2-3 weeks if the clinical presentation is consistent with either severe sinusitis or bony destruction
:*Note (2): Consider surgical intervention if the patient has either visual loss, complete ophthalmoplegia, large abscess > 1 cm, or no clinical improvement following 1-2 days of antibiotic administration
*'''3. Pathogen-directed antimicrobial therapy'''
:*'''3.1 Methicillin-resistant staphylococcus aureus (MRSA)'''
::*Preferred regimen (1): [[Vancomycin]] 1 g IV q12h for 1 week {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week
::*Preferred regimen (2): [[Vancomycin]]  1 g IV q12h for 1 week {{and}} [[Levofloxacin]] 750 mg IV q24h for 1 week {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided q8h for 1 week


===Ocular toxocariasis===
:*'''3.2 Non-MRSA organisms'''
*Ocular larval migrans <ref name="pmid12692098">{{cite journal| author=Despommier D| title=Toxocariasis: clinical aspects, epidemiology, medical ecology, and molecular aspects. | journal=Clin Microbiol Rev | year= 2003 | volume= 16 | issue= 2 | pages= 265-72 | pmid=12692098 | doi= | pmc=PMC153144 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12692098  }} </ref>
::*Preferred regimen (1): [[Ampicillin]]/[[Sulbactam]] 3 g IV q6h for 1 week
:* Preferred regimen: [[Albendazole]] 400 mg bd for 5 days
:* Alternative regimen: [[Mebendazole]] (some success has been reported in patients who ingest 1 g or more for a 21-day course)
::Note (1): Symptomatic treatment, including administration of corticosteroids, has been helpful for suppressing the intense allergic manifestations of the infection.
::Note (2): Ocular larval migrans is treated by surgery (vitrectomy), antihelminthic chemotherapy, {{and}} / {{or}} corticosteroids


===Ocular toxoplasmosis===
::*Preferred regimen (2): [[Ceftriaxone]] 1-2 g IV q12h for 1 week
*Ocular toxoplasmosis <ref name="pmid15194258">{{cite journal| author=Montoya JG, Liesenfeld O| title=Toxoplasmosis. | journal=Lancet | year= 2004 | volume= 363 | issue= 9425 | pages= 1965-76 | pmid=15194258 | doi=10.1016/S0140-6736(04)16412-X | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15194258  }} </ref>
:* Preferred regimen (Active chorioretinitis; meningitis; lowered resistance due to steroids or cytotoxic drugs) : ([[Pyrimethamine]] (pyri) 200 mg po once on 1st day, then 50-75 mg q24hours ) + ( [[Sulfadiazine]] 1-1.5 gm po qid ) + ( [[Leucovorin]] ([[Folinic acid]]) 5-20 mg 3times/week].
::Note (1): Treat 1-2 week beyond resolution of signs/symptoms; continue leucovorin 1 week after stopping pyrimethamine.
::Note (2): For congenital toxoplasmosis, toxoplasma meningitis in adults, chorioretinitis, add [[Prednisone]] 1 mg/kg/day in 2 divided doses until CSF protein concentration falls or vision-threatening inflammation subsides.
::Note (3):Adjust folinic acid dose by following CBC results.


===Ocular tuberculosis===
::*Preferred regimen (3): [[Clindamycin]] 300 mg IV q6h for 1 week


* Ocular tuberculosis<ref>{{Cite journal| doi = 10.1164/rccm.167.4.603| issn = 1073-449X| volume = 167| issue = 4| pages = 603–662| last1 = Blumberg| first1 = Henry M.| last2 = Burman| first2 = William J.| last3 = Chaisson| first3 = Richard E.| last4 = Daley| first4 = Charles L.| last5 = Etkind| first5 = Sue C.| last6 = Friedman| first6 = Lloyd N.| last7 = Fujiwara| first7 = Paula| last8 = Grzemska| first8 = Malgosia| last9 = Hopewell| first9 = Philip C.| last10 = Iseman| first10 = Michael D.| last11 = Jasmer| first11 = Robert M.| last12 = Koppaka| first12 = Venkatarama| last13 = Menzies| first13 = Richard I.| last14 = O'Brien| first14 = Richard J.| last15 = Reves| first15 = Randall R.| last16 = Reichman| first16 = Lee B.| last17 = Simone| first17 = Patricia M.| last18 = Starke| first18 = Jeffrey R.| last19 = Vernon| first19 = Andrew A.| last20 = American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society| title = American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis| journal = American Journal of Respiratory and Critical Care Medicine| date = 2003-02-15| pmid = 12588714}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
::*Preferred regimen (4): [[Nafcillin]] 2 g IV q4h for 1 week  {{and}} [[Ceftriaxone]] 2 g IV q24h for 1 week  {{and}} [[Metronidazole]] 30-35 mg/kg/d IV divided in 3 doses for 1 week
::* '''Intensive phase (adult)'''
:::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months


::* '''Continuation phase (adult)'''
==Periocular Infection==
:::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 4 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 4 months
*Periocular infection<ref name="pmid17700236">{{cite journal| author=Bilyk JR| title=Periocular infection. | journal=Curr Opin Ophthalmol | year= 2007 | volume= 18 | issue= 5 | pages= 414-23 | pmid=17700236 | doi=10.1097/ICU.0b013e3282dd979f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17700236  }} </ref>
:*'''1. Causative pathogens'''
::*Streptococcus spp.
::*Methicillin-sensitive Staphylococcus aureus (MSSA)
::*Methicillin-resistant Staphylococcus aureus (MRSA)
::*Hemophilus influenzae
:*'''2. Empiric antimicrobial therapy'''
::*Preferred regimen (1): [[Clindamycin]] 300-450 mg PO q6h for 1-2 weeks {{or}} [[Clindamycin]] 600-900 mg IV q8h for 1-2 weeks
::*Preferred regimen (2): [[Daptomycin]] 4 mg/kg IV qd for 1-2 weeks
::*Alternative regimen (1): [[Trimethoprim]]/[[Sulfamethoxazole]] 160 mg PO q12h for 1-2 weeks {{or}}  [[Trimethoprim]]/[[Sulfamethoxazole]] 2.5 mgkg IV q12h for 1-2 weeks
::*Alternative regimen (2): [[Doxycycline]] 100 mg IV or PO q12h for 1-2 weeks
::*Alternative regimen (3): [[Linezolid]] 600 mg IV or PO q12h for 1-2 weeks
::*Alternative regimen (4): [[Vancomycin]] 1 g IV q12h for 1-2 weeks
:*'''3. Pathogen-directed antimicrobial therapy'''
::*'''3.1 Methicillin-resistant Staphylococcus aureus'''
:::*Preferred regimen (1): [[Vancomycin]] 1 g IV q12h for 1-2 weeks
::*'''3.2 Non-MRSA organisms'''
:::*Preferred regimen (1): [[Clindamycin]] 300-450 mg PO q6h for 1-2 weeks {{or}} [[Clindamycin]] 600-900 mg IV q8h for 1-2 weeks
:::*Preferred regimen (2): [[Daptomycin]] 4 mg/kg IV qd for 1-2 weeks
:::*Alternative regimen (1): [[Trimethoprim]]/[[Sulfamethoxazole]] 160 mg PO q12h for 1-2 weeks {{or}}  [[Trimethoprim]]/[[Sulfamethoxazole]] 2.5 mgkg IV q12h for 1-2 weeks
:::*Alternative regimen (2): [[Doxycycline]] 100 mg IV or PO q12h for 1-2 weeks
:::*Alternative regimen (3): [[Linezolid]] 600 mg IV or PO q12h for 1-2 weeks


::* '''Intensive phase (pediatric)'''
==Retinal necrosis==
:::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months
*Retinal necrosis
:*'''1. Causative pathogens'''


::* '''Continuation phase (pediatric)'''
::*Herpes simplex virus (HSV) 1 and 2
:::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 4 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 4 months
::*Varicella-zoster virus (VZV)
:::: Note (1): [[Ethambutol]] should be avoided if possible because of potential ocular toxicity.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
::*Cytomegalovirus (CMV)
:::: Note (2): A short course of systemic corticosteroids may be necessary initially if there is sight-threatening inflammation.
:*'''2. Empiric antimicrobial therapy'''


===Orbital cellulitis===
::*Preferred regimen: [[Acyclovir]] 10 mg/kg IV q8h for 1-2 weeks followed by [[Acyclovir]] 400 mg PO bid for chronic maintenance


===Periocular Infection===
::*Alternative regimen (1): [[Acyclovir]] 10 mg/kg IV q8h for 1-2 weeks followed by [[Valacyclovir]] 1 g IV q8h for 6 weeks to several months followed by [[Acyclovir]] 400 mg PO bid for chronic maintenance
::*Alternative regimen (2), unresponsive: [[Foscarnet]] 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week {{and}} ([[Ganciclovir]] 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks {{or}} [[Foscarnet]] 60 mg/kg IV q8h for 2 weeks followed by 90-120 mg/kg IV q24h {{or}} [[Cidofovir]] 5 mg/kg IV for 2 weeks followed by 5 mg/kg IV q2weeks) followed by ([[Acyclovir]] 400 mg PO bid for chronic maintenance {{or}} [[Valganciclovir]] 900 mg PO qd for chronic maintenance)


===Retinal necrosis, acute, CMV===
::*Note: [[Ganciclovir]] is administered for patients with suspected CMV acute retinal necrosis. Whereas [[Foscarnet]] is administered for patients who are not immunocompromised
:*'''3. Pathogen-directed antimicrobial therapy'''


===Retinal necrosis, acute, HSV or VZV===
::*'''3.1 HSV or VZV'''
:::*Preferred regimen: [[Acyclovir]] 10 mg/kg IV q8h for 1-2 weeks followed by [[Acyclovir]] 400 mg PO bid for chronic maintenance
:::*Alternative regimen: [[Acyclovir]] 10 mg/kg IV q8h for 1-2 weeks followed by [[Valacyclovir]] 1 g IV q8h for 6 weeks to several months followed by [[Acyclovir]] 400 mg PO bid for chronic maintenance


===Retinal necrosis, progressive outer,  VZV===
::*'''3.2 Cytomegalovirus'''


===Retinitis, CMV===
:::*Preferred regimen: [[Foscarnet]] 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week {{and}} [[Ganciclovir]] 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks followed by [[Valganciclovir]] 900 mg PO qd for chronic maintenance


===Stye===
==Stye==
* '''Hordeolum'''<ref>{{ Cite web | title = Managing Eye Infections in Older Adults. | url = http://journals.lww.com/infectdis/Citation/1998/12000/Managing_Eye_Infections_in_Older_Adults_.5.aspx }}</ref>
:* 1. '''External hordeolum, for a  single lesion'''
::* Supportive therapy: application of warm compresses 4-6 times/day.
::* Note: Antibiotic therapy is questionable value for a single lesion and often not indicated.
:* 2. '''External hordeolum, for multiple/recurrent lesions'''
::* Preferred regimen (1): antistaphylococcal antibiotic therapy [[Bacitracin]] topical qd-tid
::* Preferred regimen (2): [[Erythromycin]] topical ointment up to 6 times/day, along with lid hygiene.
:* 3. '''Internal hordeolum'''
::* Supportive therapy: warm compressess in conjugation with systemic antistaphylococcal antibiotics
::* Note (1): If the lesion do not respond to this regimen, incision and drainage are indicated.
::* Note (2): Chalazion effectively treated with lid hygiene and warm compression in most circumstances.


===Uveitis, acute anterior===
==Uveitis==
*Infectious uveitis
:*'''1. Causative pathogens'''
::*Viruses
:::*Herpes simples (common)
:::*Herpes zoster (common)
:::*CMV (common)
:::*EBV
:::*Ebola
:::*Chikungunya
:::*HIV
:::*HTLV-1
:::*Mumps
:::*Parechovirus
:::*Rubella
:::*Rubeola
:::*Vaccinia
:::*West Nile virus
::*Bacteria
:::*Mycobacteria (atypical and tuberculosis)
:::*Bartonella henselae
:::*Brucella spp.
:::*Leptospira spp.
:::*Borrelia spp.
:::*Propionibacterium spp.
:::*Syphilis
:::*Tropheryma whipplei
::*Fungi
:::*Aspergillus spp.
:::*Blastomyces spp.
:::*Candida spp.
:::*Coccidioides spp.
:::*Cryptococcus spp.
:::*Histoplasma spp.
:::*Pneumocystis jirovecii
:::*Sporothrix spp.
::*Parasites
:::*Acanthamoeba
:::*Taenia solium
:::*Onchocerca spp.
:::*Toxocara spp.
:::*Toxoplasma
:*'''2. Empiric antimicrobial therapy'''
::*Preferred regimen: [[Acyclovir]] 800 mg PO q5h for 7-10 days
::*Note: Long-term prophylactic [[Acyclovir]] 400 mg PO bid may be beneficial in preventing recurrences of herpetic uveitis and development of complications


===Uveitis, Lyme disease===
===Uveitis, Lyme disease===
* Lyme uveitis<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
:* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days


==References==
==References==
{{Reflist}}
{{Reflist|2}}

Latest revision as of 17:23, 4 August 2015

Conjunctivitis

  • Mild bacterial conjunctivitis is usually self-limited, and it typically resolves spontaneously without specific treatment in immune-competent adults (except for methicillin-resistant staphylococcal conjunctivitis, gonococcal conjunctivitis, and conjunctivitis due to C. trachomatis)
  • Severe bacterial conjunctivitis requires antimicrobial therapy and is characterized by copious purulent discharge, pain, and marked inflammation of the eye.
  • Systemic antibiotic therapy is necessary to treat conjunctivitis due to Neisseria gonorrhoeae and Chlamydia trachomatis
  • Methicillin-resistant Staphylococcal infections should be treated with topical antibiotics.
  • Topical and/or oral antiviral therapy is recommended for HSV conjunctivitis to prevent corneal infection
  • Neither topical nor oral antiviral treatment is recommended to treat either adenoviral or VZV conjunctivitis. Empiric topical antibiotics may be administered to prevent secondary bacterial infection

Conjunctivitis

  • Conjunctivitis, infectious[1][2]
  • Infectious conjunctivitis
  • 1. Causative pathogens
  • Neisseria gonorrhoeae
  • Neisseria meningitidis
  • Chlamydia trachomatis
  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Streptococcus pneumoniae
  • Streptococcus haemolyticus
  • Haemophilus influenzae
  • Moraxella spp.
  • Proteus mirabilis
  • Escherichia coli
  • Pseudomonas aeruginosa
  • Adenovirus
  • Herpes simplex virus
  • Herpes zoster virus
  • 2. Conjunctivitis, neonatal prophylaxis
  • Preferred regimen (1): 0.5% Erythromycin ophthalmic ointment, single dose
  • Alternative regimen: 2.5% [[|Providone|Providone-iodine]] solution ophthalmic ointment, single dose
  • 3. Empiric antimicrobial therapy
  • Preferred regimen (1): Gentamicin/Tobramycin 0.3% ophthalmic ointment q2h to qid for 1 week
  • Preferred regimen (2): Bacitracin zinc 500U/g ophthalmic ointment qhs to qid for 1 week
  • Preferred regimen (3): Chloramphenicol 1.0% ophthalmic ointment q2h to qid for 1 week OR Chloramphenicol 0.5% solution q2h to qid for 1 week
  • Preferred regimen (4): Erythromycin 0.5% ophthalmic ointment qhs to qid for 1 week OR Azithromycin 1% ophthalmic ointment bid for 2 days then qd for 5 days
  • Preferred regimen (5): Ciprofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Ofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Levofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Moxifloxacin 0.5% ophthalmic ointment bid to tid for 1 week OR Besifloxacin 0.6% ophthalmic suspension tid for 1 week OR Gatifloxacin 0.5% ophthalmic solution tid for 1 week
  • Preferred regimen (6): Polymyxin B/Trimethoprim sulfate 10,000 U, 1 mg/mL ophthalmic solution q3h for 1 week
  • Preferred regimen (7): Polymyxin B/Neomycin 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week
  • Preferred regimen (8): Sodium sulfacetamide 10%-30% ophthalmic solution q2hr to qid for 1 week
  • Preferred regimen (9): Sulfisoxazole diolamine 4.0% ophthalmic solution qid for 1 week
  • Preferred regimen (10): Tetracycline 1.0% ophthalmic ointment q2h to qid for 1 week
  • Note (1): All regimens have similar efficacy.
  • Note (2): When empiric antimicrobial therapy is administered, the patient's age, environment, and related ocular findings may guide the treatment of choice.
  • Note (3): Some regimens are associated with transient blurring of vision.
  • Note (4): Topical steroids are not recommended for bacterial conjunctivitis.
  • 4. Pathogen-directed antimicrobial therapy
  • 4.1 Chlamydia trachomatis
  • Preferred regimen (1): Azithromycin 1 g PO, single dose
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 7 days
  • Pediatric regimen (1): Children who weigh < 45 kg: Erythromycin solution 50 mg/kg/day PO qid for 2 weeks OR Ethylsuccinate 50 mg/kg/day PO qid for 2 weeks
  • Pediatric regimen (2): Chidren who weigh ≥ 45 kg but are aged < 8 years: Azithromycin 1 g PO, single dose
  • Pediatric regimen (3): Children ≥ 8 years: Azithromycin solution 1 g PO, single dose OR Doxycycline 100 mg PO bid for 1 week
  • Neonatal regimen: Erythromycin 50 mg/kg/day PO qid for 2 weeks OR Ethylsuccinate 50 mg/kg/day PO qid for 2 weeks
  • Note (1): Neonates administered Erythromycin should be followed for signs and symptoms of infantile hypertrophic pyloric stenosis
  • Note (2): Sexual contacts of patients with C. trachomatis conjunctivitis should be treated at the same time
  • 4.2 Neisseria gonorrhoeae
  • Hyperacute bacterial conjunctivitis, adult
  • Preferred regimen: Ceftriaxone 25 mg IM, single-dose AND (Azithromycin 1 g PO, single dose OR Doxycycline 100 mg PO bid for 1 week)
  • Alternative regimen, cephalosporin-allergic: Azithromycin 2 g PO, single dose
  • Pediatric dose: Children who weigh < 45 kg: Ceftriaxone 125 mg IM, single dose OR Spectinomycin 40 mg/kg (maximum dose 2 g) IM, single dose
  • Neonatal dose: Ceftriaxone 25-50 mg/kg (maximum dose 125 mg) IV or IM, single dose
  • Note (1): The regimen provides adequate coverage for both N. gonorrhea and C. trachomatis
  • Note (2): Children who weigh > 45 kg are administered adult doses for the management of N. gonorrhoeae conjunctivitis
  • Note (3): Neisseria meningitidis must be ruled out as a causative organism before concluding that Neisseria gonorroeae is responsible
  • Note (4): Patients diagnosed with gonococcal conjunctivitis should be seen daily until resolution of conjunctivitis. Interval history, visual acuity measurement, and slit-lamp biomicroscopy should be performed daily.
  • 4.3 Staphylococcus aureus
  • 4.3.1 Methicillin-sensitive Staphylococcus aureus (MSSA)
  • 4.3.2 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 1% ophthalmic ointment qid for 2 weeks
  • 4.3.3 Methicillin-sensitive Staphylococcus epidermidis (MSSE)
  • 4.3.4 Methicillin-resistant Staphylococcus aureus (MRSE)
  • Preferred regimen: Vancomycin 1% ophthalmic ointment qid for 2 weeks
  • 4.4 Streptococcus species
  • 4.4.1 Streptococcus pnuemoniae
  • 4.4.2 Streptococcus haemolyticus
  • 4.5 Haemophilus influenzae
  • 4.6 Moraxella spp.
  • 4.7 Proteus mirabilis
  • 4.8 Escherichia coli
  • 4.9 Pseudomonas aeruginosa
  • Preferred regimen: Gentamicin/Tobramycin 0.3% ophthalmic ointment q2h to qid for 1 week OR Ciprofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Ofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Levofloxacin 0.3%-0.5% ophthalmic ointment q2h to qid for 1 week OR Moxifloxacin 0.5% ophthalmic ointment bid to tid for 1 week OR Besifloxacin 0.6% ophthalmic suspension tid for 1 week OR Gatifloxacin 0.5% ophthalmic solution tid for 1 week OR Polymyxin B/Neomycin 16,250 U, 3.5 mg/mL ophthalmic solution qid for 1 week
  • 4.10 Herpes Simplex Virus
  • Preferred regimen: Ganciclovir 0.15% ophthlamic gel qid for 1 week
  • Alternative regimen (1): Trifluridine 1% solution q4h for 1 week
  • Alternative regimen (2): Acyclovir 200 mg to 400 mg PO q5h per day for 1 week
  • Alternative regimen (3): Valacyclovir 500 mg PO tid for 1 week
  • Alternative regimen (4): Famciclovir 250 mg PO bid for 1 week
  • Note: Corticosteroids should be avoided.
  • 4.11 Varicella Zoster Virus
  • Preferred regimen: Acyclovir 800 mg PO q5hr for 1 week
  • Alternative regimen (1): Valacyclovir 1000 mg PO q8h for 1 week
  • Alternative regimen (2): Famciclovir 500 mg PO tid for 1 week

Blepharitis

  • Blepharitis is a chronic condition that may not be fully cured. It often requires chronic care and follow-up
  • Warm compresses, eyelid cleansing, and eyelid massage twice daily are recommended in the management of infectious blepharitis
  • Topical antimicrobial therapy may be prescribed, but there is insufficient evidence to confirm their efficacy in the management of blepharitis
  • In patients with chronic blepharitis that does not respond to therapy, the possibility of carcinoma should be considered, particularly if associated with a loss of eyelashes
  • Isotretinoin used to treat cystic acne is associated with significant increase in colonization of conjunctiva with Staphylococcus aureus blepharitis and disruption of tear function. Discontinuation of isotretinoin leads to improvement in many cases.

Blepharitis

  • Blepharitis, infectious[3]
  • Infectious blepharitis
  • 1. Causative pathogens
  • Staphylococcus aureus
  • Coagulase-negative Staphylococcus spp.
  • Demodex folliculorum
  • Streptococcus pyogenes
  • Herpes simplex virus
  • Varicella zoster virus
  • Papillomavirus
  • Vaccinia
  • Molluscum contagiosum
  • 2. Empiric antimicrobial therapy[4]
  • Blepharitis
  • 3. Specific considerations
  • 3.1 Meibomian gland dysfunction:
  • Preferred regimen: Doxycycline 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks OR Minocycline 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks OR Tetracycline 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks.
  • Alternative regimen (1): Erythromycin 250-500 mg PO qd for 3 weeks OR Azithromycin 250-500 mg PO 1-3 times a week for 3 weeks OR Azithromycin 1 g PO once per week for 3 weeks
  • Note: Tetracyclines are contraindicated among pregnant women, nursing women, and young children < 8 years of age
  • 3.2 Dry eye
  • Preferred regimen: Cyclosporine 0.05% ophthalmic emulsion bid for 6 months
  • 3.3 Ocular Rosacea
  • Preferred regimen: Doxycycline 100 mg PO qd until clinical improvement followed by 40 mg PO qd for 2-6 weeks OR Minocycline 100 mg PO qd until clinical improvement followed by 50 mg PO for 2-6 weeks OR Tetracycline 1000 mg PO until clinical improvement followed by 250-500 mg PO qd for 2-6 weeks OR (Azithromycin 250-500 mg PO 1-3 times a week for 3 weeks AND Tacrolimus 0.1% topical bid for 3 weeks) OR (Azithromycin 1 g PO once per week for 3 weeks AND Tacrolimus 0.1% topical bid for 3 weeks)
  • 4. Pathogen-directed antimicrobial therapy
  • 4.1 Staphylococcus spp.
  • 4.2 Demodex folliculorum
  • Preferred regimen: Metronidazole 2% gel bid for 1-2 weeks
  • Alternative regimen: Ivermectin 200 microgram/kg once weekly for 2 weeks

Endophthalmitis

  • Endogenous endophthalmitis is caused by the hematologic dissemination of an infection to the eyes. Systemic antibiotics are recommended in endogenous bacterial endophthalmitis because the source of the infection is distant from the eye.
  • Most common extraocular foci of infection include liver abscess, pneumonia, endocarditis, and soft tissue infection.
  • Bacterial and fungal cultures from vitreous samples are necessary in the management of endophthalmitis
  • Immediate vitrectomy is often necessary

Endophthalmitis

  • Endophthalmitis, infectious[5]
  • 1. Causative pathogens
  • Staphylococcus epidermidis
  • Staphylococcus aureus
  • Streptococci
  • Enterococci
  • Bacillus spp.
  • Escherichia coli
  • Neisseria meningitidis
  • Klebsiella spp.
  • Propionibacterium spp.
  • Corynebacterium spp.
  • Pseudomonas aeruginosa
  • Candida spp.
  • Aspergillus spp.
  • Fusarium spp.
  • 2. Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin 1 mg per 0.1 mL normal saline intravitreal injection, single dose AND Vancomycin 1 g IV bid for 2 weeks AND Ceftazidime 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose AND Ceftazidime 1 g IV bid for 2 weeks AND Clindamycin 600-1200 mg IV bid to qid for 2 weeks
  • Note (1): Re-injection should be considered if the infection does not improve beyond 48 hours of the first injection. Re-injection significantly increases the risk of retinal toxicity.
  • Note (2): In addition to intravitreal and systemic antibiotic therapy, vitrectomy is usually necessary
  • Note (3): Intravitreal and intravenous Amphotericin B may be added to the regimen if fungal endophthalmitis is suspected
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 Bacillus spp.
  • Preferred regimen: Vancomycin 1 mg per 0.1 mL normal saline intravitreal injection, single dose AND Vancomycin 1 g IV bid for 2 weeks AND Clindamycin 600-1200 mg IV bid to qid for 2 weeks
  • Note: In addition to antimicrobial therapy, vitrectomy is usually necessary
  • 3.2 Non-Bacillus gram-positive bacteria
  • Preferred regimen: Vancomycin 1 mg per 0.1 mL normal saline intravitreal injection, single dose AND Vancomycin 1 g IV bid for 2 weeks
  • Note: In addition to antimicrobial therapy, vitrectomy is usually necessary
  • 3.3 Gram-negative bacteria
  • Preferred regimen: Ceftazidime 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose AND Ceftazidime 1 g IV bid for 2 weeks
  • Note: In addition to antimicrobial therapy, vitrectomy is usually necessary
  • 3.4 Candida spp.
  • Preferred regimen: (Fluconazole 400-800 mg IV/PO qd for 6-12 weeks OR Voriconazole 400 mg IV/PO bid for 2 doses followed by 200-300 mg IV/PO bid for 6-12 weeks OR Amphotericin B 0.7-1.0 mg/kg IV qd for 6-12 weeks) AND Amphotericin B 5-10 microgram in 0.1 mL in normal saline intravitreal injection, single dose
  • Note (1): In addition to antimicrobial therapy, vitrectomy is usually necessary
  • 3.5 Aspergillus spp.
  • Preferred regimen: Amphotericin B 5-10 microgram in 0.1 mL normal saline intravitreal injection, single dose AND Dexamethasone 400 microgram intravitreal injection, single dose
  • Note (1): In addition to antimicrobial therapy, vitrectomy is usually necessary
  • Note (2): Repeat antimicrobial regimen in 2 days post-vitrectomy
  • 4. Special Considerations
  • 4.1 Endogenous endophthalmitis
  • 4.1.1 Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin 1 mg per 0.1 mL normal saline intravitreal injection, single dose AND Vancomycin 1 g IV bid for 2 weeks AND Ceftazidime 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose AND Ceftazidime 1 g IV bid for 2 weeks AND Clindamycin 600-1200 mg IV bid to qid for 2 weeks
  • Note (1): Re-injection should be considered if the infection does not improve beyond 48 hours of the first injection. Re-injection significantly increases the risk of retinal toxicity.
  • Note (2): In addition to intravitreal and systemic antibiotic therapy, vitrectomy is usually necessary::* Note (3): Intravitreal and intravenous Amphotericin B may be added to the regimen if fungal endophthalmitis is suspected
  • 4.2 Bleb-related endophthalmitis
  • 4.2.1 Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin 1 mg per 0.1 mL normal saline intravitreal injection, single dose AND Vancomycin 1 g IV bid for 2 weeks AND Ceftazidime 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose AND Ceftazidime 1 g IV bid for 2 weeks AND Clindamycin 600-1200 mg IV bid to qid for 2 weeks
  • Note (1): Re-injection should be considered if the infection does not improve beyond 48 hours of the first injection. Re-injection significantly increases the risk of retinal toxicity.
  • Note (2): In addition to intravitreal and systemic antibiotic therapy, vitrectomy is usually necessary
  • 4.3 Post-operative endophthalmitis
  • 4.3.1 Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin 1 mg per 0.1 mL normal saline intravitreal injection, single dose AND Ceftazidime 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose
  • Note (1): In addition to intravitreal antibiotic therapy, vitrectomy is necessary
  • Note (2): If there is no improvement in 48 h, a repeat intravitreal injection may be administered
  • Note (3): Late post-operative endophthalmitis is often caused by Propionibacterium acnes (several years post-op)
  • 4.3.2 Pathogen-directed antimicrobial therapy
  • 4.3.2.1 Gram-positive bacteria
  • Preferred regimen: Vancomycin 1 mg per 0.1 mL normal saline intravitreal injection, single dose
  • 4.3.2.2 Gram-negative bacteria
  • Preferred regimen: Amikacin 0.4 mg per 0.1 mL normal saline intravitreal injection, single dose
  • Note: Intravitreal amikacin is associated with the development of retinal microvasculitis
  • 4.4 Post-traumatic endophthalmitis
  • 4.4.1 Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin 1 mg per 0.1 mL normal saline intravitreal injection, single dose AND Ceftazidime 2.25 mg per 0.1 mL normal saline intravitreal injection, single dose AND Amphotericin B 5-10 microgram in 0.1 mL in normal saline intravitreal injection, single dose
  • Note (1): Removal of foreign bodies and debridement of necrotic tissue is necessary
  • Note (2): In addition to antimicrobial therapy, vitrectomy is necessary
  • Note (3): Systemic broad spectrum antibiotics are recommended in post-traumatic endophthalmitis

Keratitis

  • Microbial keratitis should be managed as bacterial keratitis until proven otherwise.
  • Steroids are indicated in the management of keratitis to reduce inflammation that may damage the eye.
  • Keratitis, infectious[6]
  • Bacterial keratitis
  • 1. Causative pathogens
  • Pseudomonas aeruginosa
  • Staphylococcus epidermidis
  • Staphylococcus aureus
  • Streptococcus pneumoniae
  • Serratia spp.
  • Hemophilus spp.
  • Moraxella spp.
  • Neisseria gonorrhea
  • Corynebacterium diphtheriae
  • Listeria spp.
  • Shigella spp.
  • Nocardia spp.
  • Mycobacterium spp.
  • 2. Empiric antimicrobial therapy
  • Preferred regimen (1): Ciprofloxacin 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
  • Preferred regimen (2): Ofloxacin 0.3% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (3): Levofloxacin 1.5% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (4): Moxifloxacin 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (5): Gatifloxacin 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (6): Cefazolin 5% q30min to q1h on day 1 then q2h on day 2 then q4h on days 3-14 AND Tobramycin 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14 OR Gentamicin 1.5% ophthalmic ointment q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14)
  • Alternative regimen (1), unresponsive keratitis: Vancomycin 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 AND Amikacin 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Alternative regimen (2): Erythromycin 0.5% ophthalmic ointment qhs for 1 week AND (Amikacin 5% AND/OR Vancomycin 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14)
  • Note (1) : Subconjunctival antibiotics may be helpful where there is imminent scleral spread or perforation or in cases where adherence to the treatment regimen is questionable.
  • Note (2) : Systemic therapy is necessary for suspected gonococcal infection.
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 Non-streptococcal gram-positive bacteria
  • Preferred regimen (1): Moxifloxacin 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (2): Gatifloxacin 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (3): Ciprofloxacin 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
  • Preferred regimen (4): Ofloxacin 0.3% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (5): Levofloxacin 1.5% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (6): Cefazolin 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14 AND Tobramycin 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • 3.2 Streptococcus pneumoniae
  • Preferred regimen (1): Moxifloxacin 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (2): Gatifloxacin 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (3): Ciprofloxacin 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
  • Preferred regimen (4): Ofloxacin 0.3% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (5): Levofloxacin 1.5% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (6): Cefazolin 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14 AND Tobramycin 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14
Alternative regimen, unresponsive keratitis: Vancomycin 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 AND Amikacin 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • 3.3 Nocardia spp.
  • Preferred regimen (1): Vancomycin 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14 AND Amikacin 5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (2): Erythromycin 0.5% ophthalmic ointment qhs for 1 week AND (Amikacin 5% AND/OR Vancomycin 5% q30 min on day 1 then q2h on day 2 then q4h on days 3-14)
  • 3.3 Gram-negative bacteria
  • Preferred regimen (1): Moxifloxacin 0.5% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (2): Gatifloxacin 0.3% q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • Preferred regimen (3): Ciprofloxacin 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
  • Preferred regimen (4): Ofloxacin 0.3% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (5): Levofloxacin 1.5% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (6): Cefazolin 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14 AND Tobramycin 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14
  • 3.4 Anaerobes
  • Preferred regimen (1): Ciprofloxacin 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14
  • Preferred regimen (2): Ofloxacin 0.3% ophthalmic ointment q2h for 2-3 weeks
  • Preferred regimen (3): Levofloxacin 1.5% ophthalmic ointment q2h for 2-3 weeks


  • Fungal (mycotic) keratitis[7]
  • 1. Causative pathogens
  • Candida spp.
  • Fusarium spp.
  • Aspergillus spp.
  • Curvularia spp.
  • 2. Empiric antimicrobial therapy
  • Preferred regimen (1): Natamycin 5% ophthalmic suspension q30min to q1h for 2-3 weeks
  • Preferred regimen (2): Fluconazole 1% ophthalmic suspension q1h for 2-3 weeks
  • Preferred regimen (3): Natamycin 5% ophthalmic suspension q30min to q1h for 2-3 weeks AND Fluconazole 1% ophthalmic suspension q1h for 2-3 weeks
  • Alternative regimen (1), unresponsive: Amphotericin B 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks
  • Alternative regimen (2), unresponsive: Natamycin 5% ophthalmic suspension q30min to q1h for 2-3 weeks AND Amphotericin B 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks
  • 3. Special considerations
  • Immunocompromised status, spreading ulcer, impending perforation, true perforation
  • Preferred regimen (1): Natamycin 5% ophthalmic suspension q30min to q1h for 2-3 weeks AND Fluconazole 1% ophthalmic suspension q1h for 2-3 weeks AND (Ketoconazole IV 200-400 mg q12h for 2-3 weeks OR Fluconazole IV 200 mg q12h for 2-3 weeks
  • Preferred regimen (2): Natamycin 5% ophthalmic suspension q30min to q1h for 2-3 weeks AND Amphotericin B 0.15-0.25% prepared in distilled water q15min-q30min on day 1-2 then q1h to q2h for 2-3 weeks AND (Ketoconazole IV 200-400 mg q12h for 2-3 weeks OR Fluconazole IV 200 mg q12h for 2-3 weeks
  • Note: Bacterial superinfection must be treated using Ciprofloxacin 0.3% ophthalmic ointment q15min for 6 hours then q30min for the remainder of day 1 then q1h on day 2, then q4h on days 3-14 OR (Cefazolin 5% q30min to q1h on day 1 then q1h on day 2 then q4h on days 3-14 AND Tobramycin 5% ophthalmic ointment q1h on day 1 then q2h on day 2 then q4h on days 3-14)


  • 1. Causative pathogens
  • Acanthamoeba spp.
  • Microsporidia spp.
  • 2. Empiric antimicrobial therapy
  • Preferred regimen (4): Propamidine ophthalmic ointment q1h for 1-2 weeks AND Chlorhexidine ophthalmic ointment q1h for 1-2 weeks
  • Preferred regimen (4): Polyhexamethylene biguanide 0.02% ophthalmic ointment q1h for 1-2 weeks AND Hexamidine 0.1% ophthalmic ointment q1h for 2 days then q1h for another 3 days


  • Viral keratitis[7]
  • 1. Causative pathogens
  • Herpes simplex virus (HSV)
  • 2. Empiric antimicrobial therapy
  • Preferred regimen (1): Acyclovir 3% ophthalmic ointment q5h for 2-3 weeks AND Homatropine 2% ophthalmic solution bid for 2-3 weeks
  • Preferred regimen (2): Idoxuridine 0.1% ophthalmic solution q1h in daytime and 0.5% ophthalmic ointment qhs for 1 week then 0.1% ophthalmic solution q2h in daytime and 0.5% ophthalmic ointment qhs for 2-3 weeks AND Homatropine 2% ophthalmic solution bid for 2-3 weeks

Ocular syphilis

  • 1. Pathogen-directed antimicrobial therapy[9]
  • Preferred regimen (1): Penicillin 4 MU IV q4h for 10-14 days AND Benzathine penicillin 2.4 MU IM once weekly for 3 weeks
  • Note (1): Corticosteroids (Prednisone 60-80 mg PO qd) are co-administered to decrease intra-ocular inflammation and prevent rebound inflammation from Jarisch Herxheimer reaction.
  • Note (2): All patients with presumed ocular syphilis should be tested for HIV, and all should have a lumbar puncture before starting therapy to exclude concurrent neurosyphilis.

Ocular toxocariasis

  • 1. Pathogen-directed antimicrobial therapy[10]
  • Preferred regimen: Albendazole 400 mg PO bid for 5 days
  • Alternative regimen: Mebendazole 1 g PO qd for 3 weeks
  • Note (1): Co-administration of corticosteroids is helpful for suppressing the intense allergic manifestations of the infection.
  • Note (2): Ocular larval migrans is treated by surgery (vitrectomy) and antihelminthic chemotherapy with or without corticosteroids.

Ocular toxoplasmosis

  • 1. Pathogen-directed antimicrobial therapy[11]
  • Preferred regimen: Pyrimethamine 200 mg PO qd on day 1 then 50-75 mg PO qd for 2 weeks beyond resolution of symptoms AND Sulfadiazine 1-1.5 g PO qid for 2 weeks beyond resolution of symptoms AND Leucovorin (Folinic acid) 5-20 mg PO 3 times/week for 3 weeks beyond resolution of symptoms

Ocular tuberculosis

  • 1. Pathogen-directed antimicrobial therapy[12][13]
  • 1. Adult patients
  • 1.1 Intensive phase
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) PO qd for 2 months AND Rifampin 10 mg/kg (max: 600 mg) PO qd for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) PO qd for 2 months AND Ethambutol 15-20 mg/kg (max: 1 g) PO qd for 2 months
  • 1.2 Continuation phase
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) PO qd for 4 months AND Rifampin 10 mg/kg (max: 600 mg) PO qd for 4 months
  • 2. Pediatric patients
  • 2.1 Intensive phase
  • Preferred regimen: Isoniazid 10-15 mg/kg (max: 300 mg) PO qd for 2 months AND Rifampin 10-20 mg/kg (max: 600 mg) PO qd for 2 months AND Pyrazinamide 15-30 mg/kg (max: 2 g) PO qd for 2 months AND Ethambutol
  • 2.2 Continuation phase
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) PO qd for 4 months AND Rifampin 10–20 mg/kg (max: 600 mg) PO qd for 4 months
  • Note (1): Ethambutol may be administered at a dose of 15-20 mg/kg (max: 1 g) PO qd for 2 months but is generally avoided because of potential ocular toxicity.[14]
  • Note (2): A short course of systemic corticosteroids may be necessary initially if there is sight-threatening inflammation.

Orbital cellulitis

  • 1. Causative pathogens
  • Methicillin-sensitive staphylococcus aureus
  • Methicillin-resistant staphylococcus aureus
  • Staphylococcus epidermidis
  • Streptococcus spp.
  • Moraxella spp.
  • Anaerobes
  • 2. Empiric antimicrobial therapy
  • Preferred regimen (1): Ampicillin/Sulbactam 3 g IV q6h for 1 week
  • Preferred regimen (2): Ceftriaxone 1-2 g IV q12h for 1 week
  • Preferred regimen (3): Clindamycin 300 mg IV q6h for 1 week
  • Preferred regimen (4): Nafcillin 2 g IV q4h for 1 week AND Ceftriaxone 2 g IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided in 3 doses for 1 week
  • Alternative regimen (1), MRSA suspicion: Vancomycin 1 g IV q12h for 1 week AND Ceftriaxone 2 g IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided q8h for 1 week
  • Alternative regimen (2), MRSA suspicion: Vancomycin 1 g IV q12h for 1 week AND Levofloxacin 750 mg IV q24h for 1 week AND Metronidazole 30-35 mg/kg/d IV divided q8h for 1 week
  • Alternative regimen (3), pediatric: Ampicillin/Sulbactam 200-300 mg/kg/d IV divided q6h for 1 week
  • Alternative regimen (4), pediatric: Ceftriaxone 100 mg/kg/d IV divided q12h for 1 week
  • Alternative regimen (5), pediatric: Clindamycin 20-40 mg/kg/d IV divided q12 for 1 week
  • Note (1): Oral antibiotic therapy may be extended beyond 2-3 weeks if the clinical presentation is consistent with either severe sinusitis or bony destruction
  • Note (2): Consider surgical intervention if the patient has either visual loss, complete ophthalmoplegia, large abscess > 1 cm, or no clinical improvement following 1-2 days of antibiotic administration
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 Methicillin-resistant staphylococcus aureus (MRSA)
  • 3.2 Non-MRSA organisms
  • Preferred regimen (2): Ceftriaxone 1-2 g IV q12h for 1 week
  • Preferred regimen (3): Clindamycin 300 mg IV q6h for 1 week

Periocular Infection

  • Periocular infection[15]
  • 1. Causative pathogens
  • Streptococcus spp.
  • Methicillin-sensitive Staphylococcus aureus (MSSA)
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Hemophilus influenzae
  • 2. Empiric antimicrobial therapy
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 Methicillin-resistant Staphylococcus aureus
  • Preferred regimen (1): Vancomycin 1 g IV q12h for 1-2 weeks
  • 3.2 Non-MRSA organisms

Retinal necrosis

  • Retinal necrosis
  • 1. Causative pathogens
  • Herpes simplex virus (HSV) 1 and 2
  • Varicella-zoster virus (VZV)
  • Cytomegalovirus (CMV)
  • 2. Empiric antimicrobial therapy
  • Preferred regimen: Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Acyclovir 400 mg PO bid for chronic maintenance
  • Alternative regimen (1): Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Valacyclovir 1 g IV q8h for 6 weeks to several months followed by Acyclovir 400 mg PO bid for chronic maintenance
  • Alternative regimen (2), unresponsive: Foscarnet 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week AND (Ganciclovir 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks OR Foscarnet 60 mg/kg IV q8h for 2 weeks followed by 90-120 mg/kg IV q24h OR Cidofovir 5 mg/kg IV for 2 weeks followed by 5 mg/kg IV q2weeks) followed by (Acyclovir 400 mg PO bid for chronic maintenance OR Valganciclovir 900 mg PO qd for chronic maintenance)
  • Note: Ganciclovir is administered for patients with suspected CMV acute retinal necrosis. Whereas Foscarnet is administered for patients who are not immunocompromised
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 HSV or VZV
  • Preferred regimen: Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Acyclovir 400 mg PO bid for chronic maintenance
  • Alternative regimen: Acyclovir 10 mg/kg IV q8h for 1-2 weeks followed by Valacyclovir 1 g IV q8h for 6 weeks to several months followed by Acyclovir 400 mg PO bid for chronic maintenance
  • 3.2 Cytomegalovirus
  • Preferred regimen: Foscarnet 1.2-2.4 mg/0.1 mL intravitreal injection 1-3 times per week AND Ganciclovir 5 mg/kg IV q12 for 2 weeks followed by 5 mg/kg q24h for 5-7 weeks followed by Valganciclovir 900 mg PO qd for chronic maintenance

Stye

  • 1. External hordeolum, for a single lesion
  • Supportive therapy: application of warm compresses 4-6 times/day.
  • Note: Antibiotic therapy is questionable value for a single lesion and often not indicated.
  • 2. External hordeolum, for multiple/recurrent lesions
  • Preferred regimen (1): antistaphylococcal antibiotic therapy Bacitracin topical qd-tid
  • Preferred regimen (2): Erythromycin topical ointment up to 6 times/day, along with lid hygiene.
  • 3. Internal hordeolum
  • Supportive therapy: warm compressess in conjugation with systemic antistaphylococcal antibiotics
  • Note (1): If the lesion do not respond to this regimen, incision and drainage are indicated.
  • Note (2): Chalazion effectively treated with lid hygiene and warm compression in most circumstances.

Uveitis

  • Infectious uveitis
  • 1. Causative pathogens
  • Viruses
  • Herpes simples (common)
  • Herpes zoster (common)
  • CMV (common)
  • EBV
  • Ebola
  • Chikungunya
  • HIV
  • HTLV-1
  • Mumps
  • Parechovirus
  • Rubella
  • Rubeola
  • Vaccinia
  • West Nile virus
  • Bacteria
  • Mycobacteria (atypical and tuberculosis)
  • Bartonella henselae
  • Brucella spp.
  • Leptospira spp.
  • Borrelia spp.
  • Propionibacterium spp.
  • Syphilis
  • Tropheryma whipplei
  • Fungi
  • Aspergillus spp.
  • Blastomyces spp.
  • Candida spp.
  • Coccidioides spp.
  • Cryptococcus spp.
  • Histoplasma spp.
  • Pneumocystis jirovecii
  • Sporothrix spp.
  • Parasites
  • Acanthamoeba
  • Taenia solium
  • Onchocerca spp.
  • Toxocara spp.
  • Toxoplasma
  • 2. Empiric antimicrobial therapy
  • Preferred regimen: Acyclovir 800 mg PO q5h for 7-10 days
  • Note: Long-term prophylactic Acyclovir 400 mg PO bid may be beneficial in preventing recurrences of herpetic uveitis and development of complications

Uveitis, Lyme disease

References

  1. ↑ Quinn, Christopher J.; Mathews, Dennis E. (Nov 8 2002). "Optometric clinical practice guideline care of the patient with conjunctivitis". Check date values in: |date= (help)
  2. ↑ McLeod, Stephen D.; Feder, Robert S. (2013). "Conjunctivitis: Preferred Practice Pattern - American Academy of Ophthalmology".
  3. ↑ McLeod, Stephen D.; Chang, David F. (2013). "Blepharitis: Preferred Practice Pattern - American Academy of Ophthalmology".
  4. ↑ "Blepharitis PPP 2013".
  5. ↑ Durand ML (2013). "Endophthalmitis". Clin Microbiol Infect. 19 (3): 227–34. doi:10.1111/1469-0691.12118. PMC 3638360. PMID 23438028.
  6. ↑ "= bacterial keratitis ppp 2013".
  7. ↑ 7.0 7.1 7.2 Thomas PA, Geraldine P (2007). "Infectious keratitis". Curr Opin Infect Dis. 20 (2): 129–41. doi:10.1097/QCO.0b013e328017f878. PMID 17496570.
  8. ↑ Dart JK, Saw VP, Kilvington S (2009). "Acanthamoeba keratitis: diagnosis and treatment update 2009". Am J Ophthalmol. 148 (4): 487–499.e2. doi:10.1016/j.ajo.2009.06.009. PMID 19660733.
  9. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  10. ↑ Despommier D (2003). "Toxocariasis: clinical aspects, epidemiology, medical ecology, and molecular aspects". Clin Microbiol Rev. 16 (2): 265–72. PMC 153144. PMID 12692098.
  11. ↑ Montoya JG, Liesenfeld O (2004). "Toxoplasmosis". Lancet. 363 (9425): 1965–76. doi:10.1016/S0140-6736(04)16412-X. PMID 15194258.
  12. ↑ Blumberg, Henry M.; Burman, William J.; Chaisson, Richard E.; Daley, Charles L.; Etkind, Sue C.; Friedman, Lloyd N.; Fujiwara, Paula; Grzemska, Malgosia; Hopewell, Philip C.; Iseman, Michael D.; Jasmer, Robert M.; Koppaka, Venkatarama; Menzies, Richard I.; O'Brien, Richard J.; Reves, Randall R.; Reichman, Lee B.; Simone, Patricia M.; Starke, Jeffrey R.; Vernon, Andrew A.; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society (2003-02-15). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". American Journal of Respiratory and Critical Care Medicine. 167 (4): 603–662. doi:10.1164/rccm.167.4.603. ISSN 1073-449X. PMID 12588714.
  13. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  14. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  15. ↑ Bilyk JR (2007). "Periocular infection". Curr Opin Ophthalmol. 18 (5): 414–23. doi:10.1097/ICU.0b013e3282dd979f. PMID 17700236.
  16. ↑ "Managing Eye Infections in Older Adults".
  17. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
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