Tobradex

Tobradex is a white to off-white eye suspension containing two active ingredients. Dexamethasone, a corticosteroid, damps down the redness, swelling and discomfort that follow eye surgery, while tobramycin, an aminoglycoside antibiotic, protects the healing eye against bacterial infection. The UK SmPC restricts its use to one setting: preventing and treating inflammation, and preventing infection, around cataract surgery in adults and in children from the age of two. It is not intended as a general remedy for red or sore eyes.

The product is listed as 0.1%/0.3%, meaning 1 mg of dexamethasone and 3 mg of tobramycin in every millilitre. It is supplied in 5 ml dropper bottles, and you can choose between one and five bottles. Stock may be imported, so its labelling can differ from the UK pack. Benzalkonium chloride is included as a preservative.

The SmPC dose is one drop into the affected eye every four to six hours while awake. For the first 24 to 48 hours the frequency may be stepped up to one drop every two hours during waking hours. Treatment normally continues for 14 days and must not go beyond 24 days, with the number of drops reduced gradually as the eye settles rather than stopped too early. Children aged two and over use the same dose as adults. Shake the bottle well, avoid touching the eye or lid with the tip, and close the eye gently while pressing on the inner corner for a minute afterwards to limit absorption into the body. Leave five minutes between different eye drops, and apply any eye ointment last.

Tobradex is a prescription-only medicine in the UK. It is licensed as Tobrasone/Tobradex 3 mg/ml/1 mg/ml eye drops, suspension, with Novartis Ireland Limited as the licence holder, and its SmPC and patient leaflet appear on the electronic medicines compendium. The licensed pack is a single 5 ml bottle.

The drops must not be used with herpes simplex keratitis, chickenpox, vaccinia or other viral infections of the cornea or conjunctiva, fungal or untreated parasitic eye infections, mycobacterial eye infections such as tuberculosis, untreated pus-forming infections, or allergy to either ingredient. Prolonged use of a steroid in the eye can raise eye pressure, damage the optic nerve and bring on cataract, so pressure checks are advised, especially in children under six and in people with diabetes. Steroids can also slow corneal healing, mask or encourage infection and, with intensive use, cause adrenal suppression, particularly alongside ritonavir or cobicistat. Anyone with myasthenia gravis or Parkinson’s disease, or already receiving an aminoglycoside by injection, needs extra care. Soft contact lenses should be left out; if lenses are permitted, remove them before the drop and wait 15 minutes.

Uncommon effects include raised eye pressure, eye pain, itching, irritation, discomfort and swelling of the conjunctiva, as well as headache. Blurred vision, dry eye and redness are rarer, and allergic reactions can occur. Like any eye drop, it can briefly blur vision just after use, so wait until your sight is clear before driving. If your sight becomes blurred or changes later in the course, contact the eye clinic. Your surgeon or prescriber will decide whether Tobradex is appropriate and how long it should be used.