|Year : 1990 | Volume
| Issue : 1 | Page : 3
Steroids and antibiotic eye drops combination or separate
Past President, India
R P Dhanda
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhanda R P. Steroids and antibiotic eye drops combination or separate. Indian J Ophthalmol 1990;38:3
It has been adequately established that antibiotics and steroids have their individual place in ocular therapy. It is equally clearly established that their actions are individualistic and there is no synergism between the two. Antibiotics are anti-bacterial while steroids are anti-inflammatory and anti-allergic. Because infections and inflammations are in many cases co-existent, it is only natural that there is a tendency to often use both antibiotics and steroids and for the sake of convenience they are used in combination, It is equally true that there are conditions where only antibiotics are indicated and in some of them steroids are contra-indicated, while there are allergic conditions where steroids are indicated and there is no place for use of antibiotics.
It is not unusual that in both these situations, the therapeutic approach is the easy course of using a combination of antibiotics and steroid therapy in the hope that whether it is bacterial or allergic or non-specific, this combination will cover all these conditions. This is most commonly the approach of the Eye Practitioners.
Ophthalmologists are often victim of the same thinking and in the hope of quick relief to the patient tend to use a multiple therapy approach rather than a specific medication.
The All India Ophthalmic Society has repeatedly discussed this subject and evaluated the pros and cons of a blind combination therapy. It has been a consensus that of all the combined therapies, combinations of antibiotics and steroid eye drops is undesirable for more than one reason. Antibiotic therapy where not indicated has the disadvantage thatthe patient may develop resistance to the drug and may not respond when antibiotic is urgently needed. More-over the patient may develop allergy to the antibiotic and neomycin is more often the cause. Steroid therapy when not indicated can aggravate the infection particularly the viral infection and if indiscriminately used for long periods may cause steroid induced cataract and glaucoma. Steroids have also the disadvantage that they cause quick symptomatic relief and hence more often are indiscriminately used. A combination of steroid and antibiotic eye drops should therefore be used only in specific conditions where both are indicated. A few examples will make it clear.
Spring cattarh: It is an exogenous allergy. There is no bacterial super-imposition. The treatment is sustained steroid therapy un-diluted and later diluted or antiallergic drugs. There is no place for antibiotic therapy.
Corneal graft rejection (TIR): This is a tissue immune antigen-antibody reaction. Steroid is the only anchor sheet therapy both as prophylactic and therapeutic for a prolonged period. There is again no scope for antibiotic therapy.
Auto-immune diseases: Like irido-cyclitis with or without rheumatoid factor. The therapy is steroid supported without antibiotics.
Non-specific conjunctival congestion:
Usually allergic or auto-immune. Needs short term nonspecific steriod therapy but no antibiotics.
Post-operative/traumatic tissue reaction:
Antibiotics are usually stopped in 3-5 post-operative days, but steroid therapy alone continues as long as congestion persists.
It is therefore important that steroid and antibiotic eye drops preparations should be available separately so that they can be used without antibiotics and save patients from drug resistance, drug allergy and other hazards.
It is unfortunate that most of the preparations in the market are a combination of an antibiotic and steroid as eye drops. It has been emphasized by the drug industry people that whenever they marketed a steroid alone preparation there was no market for the same. It has been mentioned that most of the general practitioners and majority of ophthalmologists prefer to use a combination, disregarding the harmful effects, of using the combined preparation. The attitude is blind coverage without emphasis on making a precise diagnosis and administering the specific therapy.
It is therefore important that both from the academic and from the therapeutic point of view, antibiotic and steroid eye drops should be available both separately and in combination and the dispensing container should have distinctive labelling whether a particular preparation contains steroid or not. It will be still better if a line of warning that the steroids can be injurious to the eye, if improperly used, is distinctively written on each container of a combined preparation.