Chloramphenicol eye drops and ointment: uses and cautions

Chloramphenicol is an antibiotic that kills bacteria by stopping them growing and spreading. For the eye it comes as drops or ointment and is used for bacterial infections such as conjunctivitis. It does not treat viral or allergic red eyes, so it is worth asking a pharmacist whether it fits your symptoms. Chloramphenicol as an ear drop treats ear infections and is prescription-only. Injection and capsule forms exist but are for serious infections and given in hospital.

The NHS explains that ointment is slightly thicker than a cream, so it stays on the eye longer and needs applying only a few times a day, but it can blur vision afterwards, which may affect driving and work. Drops do not blur vision in the same way. For more severe infections, a doctor may suggest ointment at bedtime and drops by day, because ointment keeps working while you sleep.

The 1% ointment is used as advised or 3 to 4 times a day, leaving 4 to 6 hours between doses, with about 1 centimetre squeezed between the lower lid and the eye. Eye drops are used as the leaflet or prescriber says; let a single drop fall into the eye and keep the bottle in the fridge. The pharmacy product and the prescription product are the same strength.

Wash your hands before and after each use, which stops the infection passing to the other eye. Take off the cap only just before use, do not touch the dropper or tube with fingers, and make sure the nozzle never touches your eye or skin. A mirror helps. Close the eye after a drop and press the inner corner gently for up to a minute, then wipe away spare liquid.

Use it before its expiry date and within 4 weeks of opening, and return any leftovers to the pharmacy at the end of treatment.

The NHS says to use the drops or ointment for 5 days, even if the eye seems better, and not more than 5 days unless a prescriber says so, because the eyes can become more sensitive or you could get another infection. Speak to a pharmacist or doctor if there is no improvement after 2 days or if symptoms worsen at any point. Ear drops are used for up to 1 week.

If you miss a dose, use it as soon as you remember, then continue at the usual times; if the next dose is nearly due, skip the missed one. A few extra drops are harmless and any surplus can be rinsed away with water, but contact 111 if you have used too much and have painful symptoms after rinsing, or if anyone swallows the drops or ointment.

Stinging, burning or blurred vision can happen straight after using it and last only a short time. Do not rub the eye; a clean flannel wetted with cool water, kept to yourself and washed afterwards, can ease it. Do not drive, cycle or use tools until your eyes feel normal and your vision is clear. A change in eye colour or a cloudy eye surface can occur because of the preservative in some drops. In the ear, mild stinging or itching can occur, and red, irritated skin around the ear may be dermatitis, in which case a different antibiotic may be advised.

Serious effects are rare. Call a doctor or 111 if you bruise more easily than usual, get infections more easily or feel especially tired or weak. These are signs of a blood problem and are very unlikely with eye drops, ointment or ear drops; the risk of aplastic anaemia is greater with injections. Swelling of the lips, mouth, throat or tongue needs 999. Suspected side effects can be reported through the Yellow Card scheme.

Most adults and children aged 2 and over can use it; under 2 only if prescribed. Tell a pharmacist or doctor if you have ever had an allergic reaction to chloramphenicol or another medicine, or if you or anyone in your family has had a blood problem such as aplastic anaemia.

For eye use also mention any other eye drops or ointments, contact lens use, eyesight problems, severe eye pain, swollen eyes with a rash on the face or head, a cloudy eye, unusual pupils that are irregular, enlarged or do not react to light, a recent eye injury or something in the eye, or recent conjunctivitis. Check about cancer medicines such as cyclophosphamide and immune medicines such as azathioprine or methotrexate. Alcohol and food are unrestricted and contraception is unaffected.

The NHS says chloramphenicol eye treatments and ear drops can be used in pregnancy because only tiny amounts reach the blood, but to discuss the best option with a doctor or pharmacist. If your baby is healthy it is OK while breastfeeding, though other medicines might be better and it should be for a short time only; with a family history of blood disorders you may be advised against it. Wash your hands thoroughly before picking up your baby, and tell a professional if your baby feeds poorly, is sick, has a rash or bruises easily, or seems pale or tired.