Purpose Ocular antibiotic bacterial resistance becomes problematic when: 1) intrinsically susceptible bacteria become resistance, 2) antibiotic resistance spreads from patient –to-patient, and 3) effective antibiotic treatment is unavailable. The “Standard of Care” of ocular bacterial infections will be accordingly evaluated.

Methods Based on the findings of our dedicated ophthalmic microbiology laboratory, the trends in ocular susceptibility in regards to bacterial pathogen and disease (endophthalmitis, keratitis, conjunctivitis, and blepharitis) were analyzed for evidence of acquired resistance, possible infection spread, and the armament of treatment.

Results Our studies indicate that based on the bacterial pathogen, bacterial resistance is most prevalent with endophthalmitis isolates of Staphylococcus aureus and coagulase-negative Staphylococcus. There is evidence that endophthalmitis isolates of Staphylococcus aureus may be hospital acquired. Although Haemophilus influenza and Streptococcus pneumonia isolated from conjunctivitis are probably spread patient-to patient, an increase in antibiotic resistance has not occurred. There does not appear to be a treatment problem for Pseudomonas aeruginosa keratitis based on in vitro antibiotic resistance.

Conclusion Our study concludes that antibiotic resistance does occur for ocular bacterial pathogens, but ocular infection does not spread from patient to patient. There is a plethora of effective topical antibiotic agents to treat all types of bacterial ocular infections. It is important to culture all severe ocular infections to optimize therapy and to guard against the creation of antibiotic resistant bacteria. The future of antibacterial therapy may rely on preventing infections instead of the production of new drugs.