To the Editor.
—Antibiotic therapy for bacterial keratitis may be administered in combinations of topical, subconjunctival, or even intravenous routes, although the article by Woo et al1 in the February Archives disproves the efficacy of parenteral aminoglycoside treatment of this disorder. A disclaimer was made that the "studies were performed on an uninflamed eye." In practice, however, since this condition is not found in the symptomatic patient, the conclusions are scientifically valid but may not be applicable when choosing antibiotic treatment.Topical drug penetrations are affected by pathologic conditions. Corneal infections can be associated with punctate keratopathy or actual erosions; the normal tight-junction epithelial barrier is thereby compromised, and drug penetration can be augmented.2In the inflamed eye, the blood-aqueous barrier is more permeable, resulting in more antibiotic entering the eye from the systemic circulation.3 For this reason, caution must be exercised in concluding that there be "concern
Parenteral Aminoglycoside Therapy for Bacterial Keratitis. Arch Ophthalmol. 1986;104(1):22. doi:10.1001/archopht.1986.01050130026007