Ocular toxicity of fluoroquinolones


Dr Andrew M Thompson, Section of Ophthalmology, University of Otago Dunedin School of Medicine, PO Box 913, Dunedin, New Zealand. Email: andrewthompson@ihug.co.nz


The ocular toxicity of fluoroquinolones and the risks of their use in the treatment of ocular infection were reviewed. Systematic identification, selection, review and synthesis of published English-language studies relating to fluoroquinolone use and safety in animals and humans was conducted. Although not free of complications, fluoroquinolones are generally safe when used to treat ocular infection. Ocular toxicity appears to be dose-dependent and results from class-effects and specific fluoroquinolone structures. Phototoxicity and neurotoxicity have been reported, and toxic effects on ocular collagen may be associated with Achilles tendinopathy. Corneal precipitation may provide an advantageous drug depot but delay healing and result in corneal perforation in approximately 10% of cases. Although human toxicity studies are limited, the current recommended dose for intracameral injection of ciprofloxacin is less than 25 μg. Intravitreal injections of ciprofloxacin 100 μg, ofloxacin 50 μg/mL, trovafloxacin 25 μg or less, moxifloxacin 160 μg/0.1 mL or less and pefloxacin 200 μg/0.1 mL are considered safe.