5 · Factors delaying or impairing healing
Epithelial toxicity of aminoglycosides / fluoroquinolones
Review — modulators of corneal healing › 5 · Factors delaying or impairing healing › Epithelial toxicity of aminoglycosides / fluoroquinolones
Epithelial toxicity of aminoglycosides / fluoroquinolones
Gentamicin, tobramycin, neomycin; ciprofloxacin, ofloxacin, moxifloxacin — dose-dependent
Oxford II (exp.) · IV (clin.)
Negative · Moderate–Strong
Present · established
Mechanism (anti-healing, dose-dependent)Aminoglycosides: direct epithelial cytotoxicity, inhibition of proliferation/migration, delayed closure (worst with fortified formulations and neomycin: punctate keratopathy, PED, pseudomembranes). Fluoroquinolones: better tolerated but inhibit keratocytes/epithelium in vitro; ciprofloxacin precipitates as white crystalline deposits in ulcers (mechanical hindrance to epithelialization). Keratocyte toxicity at high concentration for both classes.
ContextNecessary in bacterial keratitis, but toxicity becomes limiting with fortified aminoglycosides/prolonged use — de-escalate as soon as control is achieved.
Route & dosageTopical; commercial concentrations generally well tolerated; fortified formulations (tobramycin/gentamicin ~14 mg/mL) reserved for severe keratitis, then tapered.
Level of evidenceOxford II (consistent experimental data) · IV clinical · Scale: Moderate–Strong.
| Status | Approved antibiotics (FDA/EU/ANSM), generics available worldwide. Fortified formulations are compounded. |
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Key studies: epithelial toxicity of aminoglycosides in vitro — PMID 2707046; topical fluoroquinolones — activity and epithelial toxicity in vitro — PMID 1893771; effect of antibiotic solutions on epithelial healing — PMID 6188448.
See also: Gabison E. “Corneal wound-healing agents”. In: SFO 2023 Report — Médicaments et biothérapies en ophtalmologie, chapter 21. Full text, open access (in French).