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In early 1993, I was the sole ophthalmologist assigned to the only major US military hospital in Somalia. In a 6-week period, 113 patients with eye complaints, accounting for 165 total visits, were seen at the eye clinic. Five of these patients required air evacuation out of Somalia for treatment of keratitis or a corneal ulcer. These patients were air evacuated owing to the lack of appropriate ophthalmic antibiotic drops in the country; two of the five were urgently evacuated.
These two patients were unresponsive to the only available antibiotics, including neomycin- and gentamicin-containing preparations. More potent ophthalmic antibiotics were not available. The existing US Army medical supply system was unable to deliver a single bottle of Ciloxan (ciprofloxacin hydrochloride), Chibroxin (norfloxacin), or even pharmaceutically prepared fortified gentamicin eyedrops for these patients.
Our US Air Force liaisons estimated the cost of an urgent air evacuation flight at $6500 per hour.
Stein EA. The $94 250 Bottle of Eyedrops. Arch Ophthalmol. 1994;112(12):1510-1511. doi:10.1001/archopht.1994.01090240016007