A sterile, multi-dose ophthalmic solution combining a mydriatic-cycloplegic (Atropine), a broad-spectrum bacteriostatic antibiotic (Chloramphenicol), and a potent corticosteroid (Dexamethasone). It is primarily indicated for the management of severe ocular inflammation and infection where cycloplegia is required to relieve pain and prevent synechiae formation. This combination is a mainstay in treating conditions like severe uveitis, post-operative inflammation, and penetrating ocular injuries with infection risk.
Adult: 1-2 drops into the affected eye(s) every 4 to 6 hours. In severe conditions, may be used every 1-2 hours initially, tapering as inflammation subsides. Frequency and duration MUST be determined by an ophthalmologist.
Note: 1. Wash hands. 2. Tilt head back. 3. Gently pull lower eyelid to form a pouch. 4. Instill prescribed drops without touching the dropper tip. 5. Close eyes gently for 1-2 minutes. 6. Apply gentle pressure on the nasolacrimal duct (inner corner of eye) for 1 minute to minimize systemic absorption. 7. Wait at least 5-10 minutes before instilling any other eye drops.
The combination exerts a triple action: 1) Atropine competitively blocks acetylcholine at muscarinic (M3) receptors of the iris sphincter and ciliary muscle, causing pupillary dilation (mydriasis) and paralysis of accommodation (cycloplegia). This relieves pain from ciliary spasm and prevents formation of posterior synechiae. 2) Chloramphenicol inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, preventing peptide bond formation. It is bacteriostatic against a wide range of Gram-positive and Gram-negative bacteria, including H. influenzae and S. aureus. 3) Dexamethasone binds to glucocorticoid receptors, inducing the synthesis of anti-inflammatory proteins (lipocortins) and inhibiting the production of pro-inflammatory mediators (prostaglandins, leukotrienes, cytokines). It suppresses inflammation, capillary dilation, edema, and fibroblast proliferation.
Pregnancy: Category C (US FDA). All three components cross the placenta. Atropine: No well-controlled studies. Chloramphenicol: 'Gray baby syndrome' risk with systemic use in third trimester; topical risk is low but considered. Dexamethasone: Potential for fetal harm. Use only if potential benefit justifies potential fetal risk. Avoid prolonged use.
Driving: STRICTLY NOT ADVISED during treatment. Cycloplegia causes significant blurring of vision (especially near vision) and photophobia, impairing the ability to drive or operate machinery. Effects can last days after discontinuation of atropine.
| Other Anticholinergics (e.g., Ipratropium, Tiotropium, Scopolamine, TCAs) | Additive systemic anticholinergic side effects (dry mouth, urinary retention, tachycardia, confusion). | Moderate |
| Systemic Corticosteroids (e.g., Prednisolone) | Additive systemic steroid effects (hyperglycemia, adrenal suppression, osteoporosis). | Moderate |
| Warfarin and other Coumarin Anticoagulants | Chloramphenicol may inhibit metabolism, increasing anticoagulant effect and risk of bleeding. | Major |
| Phenytoin, Phenobarbital | Chloramphenicol may increase levels of these drugs; these drugs may decrease chloramphenicol levels. | Moderate |
| Sulfonylureas (e.g., Glipizide) | Chloramphenicol may increase hypoglycemic effect. Dexamethasone may increase blood glucose. | Moderate |
| Cholinesterase Inhibitors (e.g., Pilocarpine, Physostigmine) | Direct pharmacological antagonism with Atropine, reducing therapeutic effect of both. | Major |
Same composition (Atropine (1% w/v) + Chloramphenicol (0.5% w/v) + Dexamethasone (0.1% w/v)), different brands: