Corneal deposits after the topical use of ofloxacin in two children with vernal keratoconjunctivitis.

Corneal deposits after the topical use of ofloxacin in two children with vernal keratoconjunctivitis Topical fluoroquinolones are broad spectrum, bactericidal agents with activity against both Gram positive and Gram negative corneal pathogens. Single drug administration with topical fluoroquinolones has been effectively used in treatment of bacterial ulcerative kera-titis. The drugs are safe, but a white crystalline deposit, that in most cases spontaneously dissolved , has been reported 1–4 with ciprofloxacin 0.3% and norfloxacin 0.3%. Up to now this side effect has not been described with ofloxacin 0.3%. We present two children with severe vernal conjunctivitis who developed corneal deposits after use of ofloxacin 0.3% eye drops. Material and methods Patient 1 A 6 year old boy with vernal keratoconjuncti-vitis (VKC) developed a painful right eye while on holiday. His ophthalmologist diagnosed a corneal ulcer and prescribed ofloxacin eye drops followed by ofloxacin ointment four times a day for 3 weeks, associated with pred-nisolone drops. As the inflammation in the right eye persisted, the child was referred to our department. Slit lamp examination revealed mild VKC and a corneal ulcer with a dense, white, sharply demarcated crystalline deposit (Fig 1). All topical treatment was discontinued , but since the deposit did not spontaneously disappear and inflammation persisted , corneal scraping was performed 7 days later to remove the deposit. The sample was analysed by low contrast microscopy. Patient 2 A 4 year old boy was referred for severe bilateral VKC with a corneal erosion in the right eye. One month before referral the child had had a corneal erosion in the right eye caused by the rubbing of a giant papilla on his upper eyelid. After an initial good response to terramycin ointment with fluorometholone and emadine, an increase in symptoms was observed. A topical treatment with ofloxacin ointment and patching was initiated, but the inflammation persisted. On administration to our department we observed a corneal ulcer associated with a white round crystalline deposit in the right eye. Ofloxacin treatment was discontinued, but the deposit did not dissolve and inflammation persisted. Twelve days after the discontinuation of the topical treatment a corneal scraping of the deposit was performed in combination with a subtarsal injection of corticosteroids in both eyes. Results The corneal scraping was analysed by micros-copy. To that end, pefloxacin was added as internal standard and the minute tissue sample was extracted with an acid (formic acid, pH 3.0) mixture …