Current regulations allow dispensing opticians to sell or supply chloramphenicol eye drops up to 0.5 per cent strength or ointment up to one per cent strength for acute bacterial conjunctivitis only. So, although you may think it sensible to sell or supply to a patient to prevent bacterial infection in the case of a minor corneal abrasion or superficial punctate keratitis associated with contact lens wear.
Use of chloramphenicol during maternity, breastfeeding and for young children is contra-indicated. It should be used with precaution in patients with a family history of blood disorders, those using bone marrow suppressive agents, or needing prolonged treatment. More relevant is that certain strains and species of bacteria are resistant to its effects and infection can worsen during treatment. However, this doesn’t seem to be getting more widespread. (3)
Particular types of infections, largely associated with contact lens wear, are more likely to be of this resistant type. Therefore, chloramphenicol should not be used for bacterial conjunctivitis associated with contact lens wear or if the particularly aggressive bacteria Pseudomonas aeruginosa (capable of causing corneal penetration in 24 hours) is suspected. (4) One further point regarding sending contact lens patients to the pharmacy for any form of ‘red-eye’ treatment is that pharmacists’ professional bodies advise referring contact lens wearers with such conditions to their contact lens practitioner.