Dexamethasone with tobramycin

How it works

Dexamethasone suppresses inflammation by inhibiting inflammatory mediators and vascular permeability, while tobramycin binds the bacterial 30S ribosomal subunit to inhibit protein synthesis, providing broad activity especially against Gram-negative organisms including Pseudomonas.

Prescribing in practice

• The corticosteroid component must not be used in undiagnosed red eye or suspected herpes simplex (dendritic) keratitis, where it risks corneal perforation, so a viral cause must be excluded first.
• Prolonged use can raise intraocular pressure and promote cataract and secondary infection, so treatment should be short and supervised.
• Tobramycin may cause local hypersensitivity and surface toxicity; discontinue if allergic reaction or persistent irritation develops.

Monitoring

Monitor intraocular pressure with extended use and review corneal status and clinical response, stopping if infection or inflammation worsens.

Counselling the patient

• Use only for the prescribed short course and shake the suspension before instilling.
• Report increasing pain, redness, swelling or any change in vision promptly.
• Remove contact lenses during treatment unless your clinician advises otherwise.

Evidence & guidelines

Fixed dexamethasone-tobramycin eye preparations are an established choice for post-operative and infective-inflammatory ocular conditions, with safety depending on excluding viral keratitis and limiting course length.