NCLEX Review Guide: Antiinfective Eye Medications

Types of Antiinfective Eye Medications

• Antibiotics treat bacterial infections like conjunctivitis, keratitis, and endophthalmitis. Common examples include erythromycin, gentamicin, and ciprofloxacin eye drops/ointments.
• Antivirals combat viral infections such as herpes simplex keratitis. Trifluridine (Viroptic) is the primary topical antiviral for ocular use.
• Antifungals address fungal keratitis and endophthalmitis, though less commonly used. Natamycin is the only FDA-approved topical antifungal for eyes.

Frequently Used Antibiotics

• Erythromycin ophthalmic ointment is the standard prophylaxis for neonatal conjunctivitis and treats gram-positive bacterial infections. Applied as a thin ribbon in the lower conjunctival sac.
• Gentamicin eye drops provide broad-spectrum coverage against gram-negative bacteria including Pseudomonas. Monitor for ototoxicity with prolonged use.
• Ciprofloxacin (Ciloxan) is a fluoroquinolone effective against both gram-positive and gram-negative bacteria. Particularly useful for corneal ulcers and severe infections.
• Tobramycin (Tobrex) targets gram-negative bacteria and is often used for external ocular infections. Available in both drop and ointment forms.

Proper Eye Drop Installation

1. Wash hands thoroughly and don clean gloves
2. Have patient tilt head back and look up
3. Pull down lower eyelid to create conjunctival sac
4. Instill prescribed number of drops into sac, not directly on cornea
5. Have patient close eyes gently for 1-2 minutes
6. Apply gentle pressure to nasolacrimal duct to prevent systemic absorption

Eye Ointment Application

1. Follow same initial preparation as eye drops
2. Apply thin ribbon of ointment (about ¼ inch) along lower conjunctival sac
3. Have patient close eyes and roll eyeball to distribute medication
4. Warn patient about temporary blurred vision lasting 15-30 minutes

Assessment Priorities

• Assess for drug allergies, especially to sulfonamides, aminoglycosides, or fluoroquinolones before administration
• Monitor for signs of superinfection with prolonged antibiotic use, including increased discharge or worsening symptoms
• Evaluate treatment effectiveness by observing decreased redness, discharge, and patient-reported symptom improvement
• Document baseline visual acuity and eye appearance for comparison during treatment

Frequently Missed Concepts

• Pitfall: Confusing prophylactic vs. therapeutic use - Remember erythromycin is prophylactic for ALL neonates, not just high-risk deliveries
• Pitfall: Forgetting nasolacrimal pressure - This prevents systemic absorption and is especially important with aminoglycosides
• Pitfall: Mixing up ointment vs. drops timing - Ointments cause longer-lasting blurred vision, so educate patients accordingly