Topical ocular local anaesthetics as an adjunctive measure in the day-1 treatment of bacterial keratitis

ABSTRACT

Introduction

The day-1 topical antibiotic treatment for bacterial keratitis (BK) can have a significant impact on treatment outcomes. Symptoms associated with this condition (pain, photophobia, blepharospasm and increased lacrimation) may compromise the effectiveness of topical antibiotic treatment by reducing the antibiotic contact time with the cornea. Topical ocular local anaesthetics (TOLAs) have the potential to alleviate these symptoms and thus potentiate the effect of the antibiotic drops instilled.

Areas covered

The literature on possible ocular side-effects of TOLAs was searched using Google and PubMed databases (Filters: Humans, English, abstract available), with no filters applied for date of publication. Relevant papers were reviewed, and possible barriers to their use on day-1 in the treatment of BK were identified, examined, and either found to be not applicable to short term use or strategies were identified to resolve any barriers. Published evidence to support the possible potentiation of antibiotic effect via the use of TOLAs was also reviewed.

Expert opinion

Perceived barriers to the short-term use of TOLAs in BK are not supported by the literature, and there is evidence to suggest that higher corneal antibiotic concentrations may be achieved by using TOLAs in conjunction with topical antibiotic drops in BK on day-1.

KEYWORDS:

• adjunctive bacterial keratitis treatments
• bacterial keratitis
• day-1 bacterial keratitis treatments
• topical ocular local anaesthetics
• topical local anaesthetics and bacterial keratitis

Article highlights

• First paper to formally address the use of TOLAs as an adjunctive treatment in the day-1 antibiotic treatment of BK

• Side-effects and perceived barriers to the use of TOLAs in the day-1 treatment of BK addressed and resolved

• Evidence for the possible potentiation of antibiotic effect in BK treatment via the adjunctive use of TOLAs presented

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contribution statement

JG Pearce conceived the article concept, conducted the literature reviews and produced the initial draft of the paper. BB Rai revised the initial, and subsequent, versions of the manuscript and provided ophthalmological oversight and advice with regard to the use of TOLAs in the treatment of BK in his own clinical practice.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.