Tobramycin Eye Drops / Ointment (tobramycin (ophthalmic))
Also sold as: Tobaflox, Tobrex, Tobradex (tobramycin + dexamethasone), Ocutob
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Eye drops 0.3% solution (5 mL) +2
Indications
- Bacterial conjunctivitis (mild to severe)
- Bacterial keratitis (corneal ulcer)
- Bacterial blepharitis
- Perioperative prophylaxis (post-cataract, post-corneal procedures)
- Infected dacryocystitis (adjunct)
Adult Dosing
Bacterial conjunctivitis (mild to moderate)
1–2 drops in affected eye(s)
Every 4 hours (q4h) for 7–10 days
Ointment: apply small ribbon BD–TDS.
Bacterial conjunctivitis (severe) / bacterial keratitis
2 drops in affected eye(s)
Every 1 hour for first 24–48 hours, then taper to every 4 hours as infection improves
For bacterial keratitis, ensure culture and sensitivity before starting if possible. Consider specialist referral.
Perioperative prophylaxis
1–2 drops
QID starting 1 day before surgery, continue for 5–7 days post-operatively
Per surgeon protocol.
Pediatric Dosing
Same regimen as adults. Tobramycin ophthalmic is considered safe in infants ≥ 2 months.
Pregnancy & Lactation
Pregnancy: Category B
Topical ophthalmic use results in negligible systemic absorption. Considered safe in pregnancy.
Lactation: Safe
Systemic absorption is minimal with topical ophthalmic use. No clinically significant amounts expected in breast milk.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Other topical ophthalmic antibiotics | Additive or antagonistic effects possible; combination generally not recommended without specific indication | Minor |
| Systemic aminoglycosides (IV gentamicin, amikacin) | Theoretical additive nephrotoxicity/ototoxicity; topical absorption is negligible so risk is minimal | Minor |
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Side Effects
Common
- Transient burning or stinging on instillation
- Conjunctival hyperemia (mild)
- Lid itching or swelling (allergic)
- Lacrimation
- Blurred vision (transient, especially with ointment)
Serious / Discontinue If
- Allergic conjunctivitis / contact dermatitis
- Corneal toxicity (with prolonged use or preservative — benzalkonium chloride)
- Secondary fungal or bacterial superinfection (with combination steroid products)
- Delayed corneal healing (steroid component in Tobradex)
Contraindications
- Hypersensitivity to tobramycin or any aminoglycoside
- Viral keratitis (herpes simplex) — avoid steroid combination (Tobradex)
- Fungal eye infections — avoid steroid combination
- Mycobacterial ocular infections
- Tobradex specifically: contraindicated in untreated bacterial infection (if used for steroid only)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Tobrex 0.3% Eye Drops | Alcon | ₹145/5 mL |
| Tobaflox 0.3% Eye Drops | Sun Pharma | ₹95/5 mL |
| Tobradex Eye Drops (tobramycin 0.3% + dexamethasone 0.1%) | Alcon | ₹165/5 mL |
| Ocutob 0.3% Eye Drops | FDC Ltd | ₹78/5 mL |
Monitoring Required
- Clinical response — resolution of discharge, hyperemia, and symptoms by day 3–5
- Corneal examination — if no improvement after 48 hours, reconsider diagnosis (viral/fungal?)
- Culture & sensitivity — if severe keratitis or no response to empirical therapy
- Intraocular pressure — monitor if using steroid combination (Tobradex) for >10 days
- Posterior subcapsular cataract — with prolonged Tobradex use
Patient Counseling Points
- Wash hands thoroughly before instilling eye drops.
- Tilt head back, pull down lower eyelid, and instil 1–2 drops into the conjunctival sac.
- Do not let the dropper tip touch the eye, eyelid, or any surface — to prevent contamination.
- Keep eyes closed for 1–2 minutes after instillation; blot excess with a tissue.
- Do not wear contact lenses during active eye infection — resume only after full resolution and doctor clearance.
- Complete the full course even if symptoms improve early — stopping early risks relapse.
- Discard the bottle after course completion — do not reuse for future infections.
- If using Tobradex (steroid combination), do not use for more than 2 weeks without ophthalmologist review.
- Report worsening redness, pain, photophobia, or vision changes immediately.
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Clinically reviewed by: Dr. Ananya Pillai, MS (Ophthalmology)
Last reviewed: 2026-04-01
References
- Hwang DG. Fluoroquinolone resistance in ophthalmology and the potential role for newer ophthalmic fluoroquinolones. Surv Ophthalmol. 2004;49(Suppl 2):S79–S83.
- Alcon Laboratories. Tobrex prescribing information. 2023.
- American Academy of Ophthalmology. Bacterial Conjunctivitis PPP. 2019.
- WHO Model Formulary. Tobramycin. 2023.