A 35-year-old farmer has a large central corneal ulcer threatening vision, with 40% stromal thinning. Scrapings show gram-positive cocci in pairs. Which empirical topical regimen is most appropriate before sensitivities return?
- A Moxifloxacin 0.5% four times daily
- B Fortified cefazolin 5% plus fortified tobramycin 1.4% hourly ✓
- C Natamycin 5% hourly with oral fluconazole
- D Prednisolone acetate 1% hourly with lubricants
Correct answer: B. Fortified cefazolin 5% plus fortified tobramycin 1.4% hourly
Explanation
Sight-threatening central bacterial ulcers require broad-spectrum fortified drops given hourly: a cephalosporin or vancomycin covering gram positives combined with an aminoglycoside covering gram negatives. Fluoroquinolone monotherapy alone is reserved for smaller, less severe peripheral ulcers, and corticosteroids are avoided until infection is controlled.
Reference: Kanski's Clinical Ophthalmology, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.