How It Works
Neomycin-polymyxin B-dexamethasone works as each of the three active ingredients attacks inflammation through a different biological pathway.
- Neomycin: Neomycin is an aminoglycoside antibiotic that disrupts bacteria’s ability to synthesize certain proteins. Without these proteins, the bacteria cannot grow or replicate, and the colony eventually dies.
- Polymyxin B: This ingredient is a cyclic peptide antibiotic that binds to bacterial cell membranes and alters the membrane’s structure, eventually leading to bacterial death.
- Dexamethasone: Dexamethasone, a corticosteroid, works by suppressing prostaglandins and other chemicals that trigger inflammation. Quieting the system’s local response can help reduce the pain, redness, and swelling associated with eye trauma or infection.
By using these three agents together, the ointment provides broad-spectrum coverage against many common gram-positive and gram-negative bacteria while ensuring the patient remains comfortable while their eye heals.
| Quick Facts | |
|---|---|
| Common Brands | Maxitrol, Dexisporin |
| Drug Class | Ophthalmic antibiotic/corticosteroid combination |
| Generic Status | Generic version available |
| Availability | Prescription only |
Dosing
Neomycin-polymixin B-dexamethasone ointment provides a thick, protective coating over the eyes. Patients often apply the ointment less frequently than eye drops, or intentionally use it before bedtime for overnight treatment.
- Standard application: Providers typically recommend applying roughly half an inch of ointment into the lower eyelid pouch.
- Frequency: Depending on the severity of the condition, doctors may recommend applying the ointment up to four times daily.
- Technique: Standard guidelines recommend tilting the head back, gently pulling the lower eyelid down, and squeezing ointment into the space between the lid and eyeball. Looking downward before closing the eye can help distribute the medication.
Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. Always follow your healthcare provider’s instructions for exact dosing.
Uses
FDA-Approved Uses
Neomycin-polymyxin B-dexamethasone ophthalmic ointment is FDA-approved for the following:
- Treating inflammatory eye conditions with an existing bacterial infection or risk of bacterial infection
- Managing inflammation of the middle layer of the eye, a condition known as chronic anterior uveitis
- Protecting against infection from chemical, radiation, or thermal burns or penetration of foreign bodies, leading to a corneal injury.
- Controlling severe cases of allergic conjunctivitis for which a specialist has deemed steroid treatment necessary
Off-Label Uses
You may see neomycin-polymyxin B-dexamethasone ophthalmic ointment prescribed for uses that are not “FDA-approved.” This is a common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.
Common off-label uses for neomycin-polymyxin B-dexamethasone ophthalmic ointment currently found in clinical research and practice include:
- Post-surgical management: The ointment is frequently used after cataract or refractive surgery to prevent infection and control post-operative swelling.
- Severe blepharitis: Doctors may recommend the ointment off-label in cases where a secondary bacterial colonization has complicated the initial eyelid inflammation.
- Stye complications: While styes typically resolve with heat-based treatment, some providers may prescribe this ointment off-label if the infection begins to spread or causes localized swelling.
Side Effects
Patients generally tolerate ophthalmic steroids and antibiotics well. However, the eye is a sensitive organ and reactions can still occur.
Common Side Effects
Common side effects of neomycin-polymyxin B-dexamethasone ointment include:
- Temporary blurred vision after application
- Mild stinging or burning sensation
- Increased tear production
- Redness or discomfort at the application site
Serious Side Effects
Serious side effects are rare, but it’s important to know what to look for if they do occur. Serious side effects of using neomycin-polymyxin B-dexamethasone ophthalmic ointment can include:
- Elevated ocular pressure: Prolonged use of eye steroids can cause pressure to rise, potentially leading to glaucoma or optic nerve damage.
- Cataract formation: Long-term use of the ointment over weeks or months can lead to clouding of the eye lenses.
- Secondary infection: Steroids can mask or encourage the growth of fungal, viral, and other non-bacterial infections.
- Delayed healing: In surgical patients, steroids may slow the cornea’s self-repair rate and prolong the healing process.
Call your doctor immediately if you experience any concerning or prolonged symptoms.
Pharmacist Tips
Protect The Applicator Tip
To prevent cross-contamination, patients are advised to never let the tip of the ointment applicator touch their eyes, eyelashes, fingers, or any other surface. Contamination of the applicator can introduce new bacteria into the eye.
Be Safe With Contact Lenses
Standard guidelines suggest avoiding contact lenses entirely while using this ophthalmic ointment to treat an eye infection. The ointment can coat and damage contact lenses, and the lenses themselves may harbor bacteria. Patients are advised to hold off on using contacts until their provider approves.
Watch For Blurred Vision
The ointment can cause blurred vision, so patients are strongly cautioned to avoid driving or operating machinery after application. The blurriness may persist for several minutes, but is a temporary side effect that eventually resolves.
Finish the Course
Many people who use the ointment notice their symptoms improving within a few days, but completing the entire treatment course helps prevent recurrent and resistant infection.
Drug Interactions
Systemic interactions with ophthalmic medicines like neomycin-polymyxin B-dexamethasone ointment are rare, but certain local interactions and health conditions require caution. Known interactions with neomycin-polymyxin B-dexamethasone ointment include:
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs): Using steroid eye medications alongside topical NSAIDs like ketorolac can further increase the risk of corneal healing issues.
- Other eye drops: If you are using multiple topical eye medications, standard guidelines recommend waiting at least 5 to 10 minutes between each application. Applying the ointment last is advised because it creates a barrier around the eyes that other topicals cannot penetrate.
- Existing viral infections: Per standard guidelines, patients are cautioned not to use the ointment if they have an existing viral eye infection such as shingles or chickenpox. Steroids can cause these infections to spread rapidly.
Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.
FAQs
What is the clinical difference between Neomycin-Polymyxin B-Dexamethasone ophthalmic suspension and the ophthalmic ointment?
The suspension formulation of this medication is often used during the day for convenience and increased clarity of vision. Since the ointment formulation creates a longer-lasting barrier over the eye, it is effective for treating inflammation and many patients prefer to apply it before bed.
Can applying Neomycin-Polymyxin B-Dexamethasone cause an increase in intraocular pressure?
Yes, an increase in intraocular pressure is one of the medication’s known side effects. Dexamethasone is a corticosteroid that can interfere with the eye’s natural fluid drainage. If a patient needs to use the ointment for more than 10 days, providers often recommend a follow-up appointment to check pressure levels.
How many days is a standard prescribed course of Neomycin-Polymyxin B-Dexamethasone for a bacterial eye infection?
The standard prescribed course for neomycin-polymyxin B-dexamethasone is 7 to 10 days. A shorter treatment period can allow the infection to return, while a longer course increases the risk of steroid-related side effects.
Does Neomycin-Polymyxin B-Dexamethasone effectively treat fungal eye infections?
No, the ointment is antibiotic and used to treat bacterial infections. It is not antifungal and cannot control fungal infections. The steroid can actually make fungal growth worse by suppressing the eye’s immune response.
How long should a patient wait after applying Neomycin-Polymyxin B-Dexamethasone drops before inserting contact lenses?
Per standard guidelines, patients who wear contacts are typically advised to avoid wearing their lenses for the duration of the treatment course. Your provider will monitor the course’s progress.
Does applying Neomycin-Polymyxin B-Dexamethasone cause blurred vision immediately after?
Yes, the ointment causes blurred vision immediately after application. The ointment creates a thick barrier over the eye that can make driving or operating machinery unsafe. The blurring typically resolves without intervention in a few minutes.
Can a patient experience a contact dermatitis reaction specifically to the neomycin component?
Yes, a contact dermatitis reaction to neomycin is a known and common side effect of the medication. Eyes that become significantly redder, itchier, or more swollen may indicate a neomycin sensitivity, in which case your doctor can provide alternative solutions.
What should I do if the dropper tip of the Neomycin-Polymyxin B-Dexamethasone bottle touches the eyelid or surrounding skin?
If the dropper tip becomes contaminated, patients are advised to wipe it with a clean, sterile tissue. Those who have severe eye infections are advised to contact their pharmacist for a replacement dropper and avoid potential recontamination.
Does Neomycin-Polymyxin B-Dexamethasone interact with topical NSAIDs in the eye?
Yes, neomycin-polymyxin B-dexamethasone has a known interaction with topical NSAIDs. Using topical NSAIDS alongside this ointment can prolong the cornea’s healing process.
Comparable Medications
Neomycin-Polymyxin B-Dexamethasone Ophthalmic Ointment, Polymyxin B-Trimethoprim, Prednisolone Acetate, Tobramycin-Dexamethasone, or Ofloxacin?
Neomycin-polymyxin B-dexamethasone is a combination eye ointment used to treat inflammatory, bacteria-borne infections. It cannot treat other issues, such as viral or fungal infections, and your doctor may also recommend an alternative treatment based on factors like your medical history and severity of symptoms. Alternatives to neomycin-polymyxin B-dexamethasone ophthalmic ointment include:
Polymyxin B and Trimethoprim
From $44.99
Sold under the brand name Polytrim, this combination antibiotic is often a first-line treatment option for bacterial pink eye (conjunctivitis). However, it lacks a steroidal component. If the eye is severely swollen or painful, doctors may prefer the combination ointment over antibiotic-only Polytrim.
Prednisolone
From $59.99
Prednisolone is a potent steroid effective at reducing inflammation, but it does not contain any antibacterial components. It is often prescribed for intense inflammatory conditions like uveitis. Providers typically prefer the combination ointment if they are concerned about a bacterial infection also occurring.
Tobramycin & Dexamethasone Eye Drops
From $59.99
This combination medication, which is sold under the brand name TobraDex, is primarily used to treat infections and inflammation. The difference between TobraDex and neomycin-polymyxin B-dexamethasone is the antibiotic component. Providers often choose the tobramycin formulation to treat certain strains of resistant bacteria, or if the patient has a neomycin allergy.
Ofloxacin Eye Drops
From $39.98
This quinolone antibiotic provides coverage against a wide range of bacterial infections, and may also be used to treat corneal ulcers. However, it lacks a steroidal component and does not directly target inflammation. Doctors tend to prefer neomycin-polymyxin B-dexamethasone when suppressing inflammation and killing bacteria are both important for treatment.
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Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.