Al-Shifa Journal of            Ophthalmology (ASJO)               

Vol. 1, No. 1, January - June 2005

Aims and Scope

Information For Authors

President's Message


Ophthalmoplegic Migraine

Ocular Infections and Seasonal Variations

Repair of Lost Rectus Muscle

Sensitivity of Tests in Dry Eyes

Intravitreal Kenacort in Macular Edema

ERG in Diagnosis of Retinal Problems

Spectrum of Contact Lens Users

Corneal Thickness in Diabetes

Antimicrobial Sensitivity Pattern


Ocular Infections
Prof. Jahangir Akhtar, FRCS

Ocular infections are common (please see articles by Tania et al and Saadia in the current issue) and vary from self-limiting to sight-threatening. Infections occur in different eye structures; presentation and treatment vary accordingly. Infections can occur when tissues of the eye are exposed to pathogens not normally present, when the eye is damaged, allowing pathogens to overcome the natural defenses of the eye, or in immunosuppressed patients where normal flora may become opportunistic. In deciding on appropriate treatment, both the causative pathogen and the structure(s) affected must be considered. The most likely pathogen can often be determined based on clinical signs and symptoms, patient history, and needs to be confirmed microbiologically. Differences in drug absorption, penetration, and availability to the various structures of the eye affect treatment decisions. Severity of infection, efficacy and safety of medication, and cost/benefit ratios must be taken into consideration in choosing the proper pharmacologic management of various ocular infections.  

Since their introduction in 1990 in the United States, fluoroquinolones have rapidly become the standard of care in the topical antibiotic arena. Unfortunately, recent evidence has shown the widespread use of fluoroquinolones, not only in eye care, but also in agriculture, and general 

medical and surgical use, has lead to decreasing susceptibilities of important ocular bacterial pathogens1. The fourth-generation fluoroquinolones, moxifloxacin and gatifloxacin, were introduced in 2003 promising improved spectrum of activity and delayed development of resistance. Although these topical agents have recently been introduced in commercial form, there is already a growing body of evidence showing excellent potency in the war on ocular infections2. These include enhanced spectrum and potency for Gram-positive cocci and possibly atypical mycobacterial species, improved penetration into the anterior segment, and reduced propensity to promote the development of resistance.  

1.      Mah FS.  Fourth-generation fluoroquinolones: new topical agents in the war on ocular bacterial infections. Curr Opin Ophthalmol. 2004 Aug;15(4):316-20

 2.      Hwang DG. Fluoroquinolone resistance in ophthalmology and the potential role for newer ophthalmic fluoroquinolones. Surv Ophthalmol. 2004 Mar;49 Suppl 2:S79-83.