Statement of Need

The world of ocular viral and bacterial infection is continuously in flux: global travelers spread viruses and bacteria to new places; microorganisms exchange genes that affect resistance and virulence; and new medical procedures (eg, intravitreal injections) create new opportunities for ocular infection.

For these and other reasons, diagnosis and treatment continue to be challenging. For example, viral infections may be misdiagnosed as bacterial and therefore treated incorrectly. And as ongoing surveillance studies confirm, antibiotic resistance is increasing steadily among common ocular pathogens and multidrug resistance is widespread, putting old treatment paradigms into question.1,2

In order to make sound, evidence-based decisions, clinicians must be informed of the development of new and potentially more accurate in-office and laboratory-based techniques for the diagnosis of ophthalmic infection, including how to distinguish between viral and bacterial infections.3,4

With respect to treatment, clinicians need to understand current resistance patterns, the pharmacokinetics and pharmacodynamics of ocular antimicrobials for specific infectious threats, and the ways that newer agents—including those with new vehicles and those that combine antiviral and antibacterial therapies—can be optimally used.5-7 Beyond approved therapeutic applications, an emerging body of research is accumulating data on the off-label use of antibiotics in bacterial keratitis and antimicrobial prophylaxis for ocular surgery.8,9 Finally, managing infections caused by exotic or rare pathogens (fungal, amoebic, atypical) may require unfamiliar diagnostic and treatment modalities.10

Topics in Ocular Antiinfectives aims to address the evolving challenges described above, helping ophthalmologists maintain competencies and narrow gaps between actual and optimal clinical practice by providing updated information about prevalence patterns and diagnostic and treatment strategies. As an enduring resource, this ongoing series will support physicians who desire to make evidence-based antiinfective choices across a range of ophthalmic clinical and patient settings.


  1. Sanfilippo CM, Morris TW, Deane J, et al. Antibiotic resistance profile of ocular pathogens – an update from the 2013 US ARMOR Surveillance Study. Poster presented at the Association for Research in Vision and Ophthalmology Meeting. May 3-8, 2014; Orlando, FL.
  2. Blondeau JM, Sanfilippo CM, Morris TW, et al. In vitro antibiotic susceptibility profile of ocular pathogens – results from the first ARMOR Canada Surveillance Study. Poster presented at the Association for Research in Vision and Ophthalmology Meeting. May 3-8, 2014; Orlando, FL.
  3. Sambursky R, Tauber S, Schirra F, et al. The RPS adeno detector for diagnosing adenoviral conjunctivitis. Ophthalmology. 2006;113(10):1758-64.
  4. Steensels D, Verhaegen J, Lagrou K. Matrix-assisted laser desorption ionization time of flight-mass spectrometry for the identification of bacteria and yeasts in a clinical microbiological laboratory: a review. Acta Clin Belg. 2011;66:267-73.
  5. Affeldt J, Gadaria-Rathod N, Fernandez KB, Asbell PA. Ganciclovir in the treatment of ophthalmic viral infections: case reports. US Ophthalmic Review. 2012;5(2):100-4.
  6. Akpek EK, Vittitow J, Verhoeven RS, et al. Ocular surface distribution and pharmacokinetics of a novel ophthalmic 1% azithromycin formulation. J Ocul Pharmacol Ther. 2009;25:433-9.
  7. Yoon J, Jekle A, Najafi R, et al. Virucidal mechanism of action of NVC-422, a novel antimicrobial drug for the treatment of adenoviral conjunctivitis. Antiviral Res. 2011;92:470-8.
  8. Schechter BA, Parekh JG, Trattler W. Besifloxacin ophthalmic suspension 0.6% in the treatment of bacterial keratitis: a retrospective safety surveillance study. J Ocul Pharmacol Ther. 2015 Mar;31(2):114-21.
  9. Majmudar PA, Clinch TE. Safety of besifloxacin ophthalmic suspension 0.6% in cataract and LASIK surgery patients. Cornea. 2014 May;33(5):457-62.
  10. Garg P. Fungal, mycobacterial, and nocardia infections and the eye: an update. Eye. 2012;26:245-51.

Off-label Use Statement: This work discusses off-label uses of antiinfective medications.

General Information: This CME activity is sponsored by the University of Florida College of Medicine and is supported by an unrestricted educational grant from Shire.

Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Florida College of Medicine and Candeo Clinical/Science Communications, LLC. The University of Florida College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. 

Credit Designation Statement: The University of Florida College of Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.