The Role of Antibiotics in Oculoplastic Surgery

  • Jean-Paul J. Abboud
  • Natalie Homer
  • Aaron Fay


The use of antibiotics in the treatment of active periocular infections and in the prevention of postoperative infections has gained special interest in the oculoplastic community. The emergence of drug-resistant organisms has changed antibiotic selection in the treatment of periocular infection and also placed an emphasis on antibiotic stewardship. Infections of the eyelids, orbit, and lacrimal system arise from different etiologies and, thus, different organisms. The prophylactic use of antibiotics during surgery of the orbit, eyelids, or lacrimal system should be based on evidence-based studies. The purpose of this chapter is to review the current treatment of periocular infections and the evidence for the use of prophylactic antibiotics before, during, and after oculoplastic surgery.


Cellulitis Orbital cellulitis Antibiotic prophylaxis Antibiotic stewardship 


  1. 1.
    Gould K. Antibiotics: from prehistory to the present day. J Antimicrob Chemother. 2016;71(3):572–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Fleming A. On the antibacterial action of cultures of a penicillium, with special reference to their use in the isolation of B. influenzæ. Br J Exp Pathol. 1929;10(31):226–36.PubMedCentralGoogle Scholar
  3. 3.
    Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA. 1999;281(1):61–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Garlock JH, Seley GP. The use of sulfanilamide in surgery of the colon and rectum: preliminary report. Surgery. 1939;5:787–90.Google Scholar
  5. 5.
    Miles AA, Miles AA, Burke J. The value and duration of defence reactions of the skin to the primary lodgement of bacteria. Br J Exp Pathol. 1957;38(1):79–96.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery. 1961;50:161–8.PubMedGoogle Scholar
  7. 7.
    Garner JS. CDC guideline for prevention of surgical wound infections, 1985. Supersedes guideline for prevention of surgical wound infections published in 1982. (Originally published in November 1985). Revised. Infect Control. 1986;7(3):193–200.CrossRefPubMedGoogle Scholar
  8. 8.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250–78.CrossRefGoogle Scholar
  9. 9.
    Blaser MJ. Missing microbes: how the overuse of antibiotics is fueling our modern plagues. New York: Henry Holt and Co., Inc.; 2014.Google Scholar
  10. 10.
    Jin JF, Zhu LL, Chen M, Xu HM, Wang HF, Feng XQ, Zhu XP, Zhou Q. The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection. Patient Prefer Adherence. 2015;9:923–42.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Bialasiewicz AA. Indications for the use of antibiotics in ophthalmology. In: Gramer E, Kampik A, editors. Pharmakotherapie Am Auge: Internationales Symposium Der Universitatsaugenklinik Würzburg. Berlin: Springer; 1992. p. 268–75.Google Scholar
  12. 12.
    Mohan ER, Kabra S, Udhay P, Madhavan HN. Intracanalicular antibiotics may obviate the need for surgical management of chronic suppurative canaliculitis. Indian J Ophthalmol. 2008;56:338–40.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Buttanri IB, Serin D, Akbaba M, Karslioğlu S. Incision-sparing management of canaliculitis. Orbit. 2014;33(5):356–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002;347:408–15.CrossRefPubMedGoogle Scholar
  15. 15.
    Sweeney CJ, Gilden D. Ramsay hunt syndrome. J Neurol Neurosurg Psychiatry. 2001;71(2):149–54.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Zaveri J, Cohen AJ. Lacrimal canaliculitis. Saudi J Ophthalmol. 2014;28(1):3–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases Society of America. Infectious Diseases Society of America. Published June 18, 2014. Accessed 12 May 2017.
  18. 18.
    Malekpour M, Bridgham K, Neuhaus N, Widom K, Rapp M, Leonard D, et al. Utility of prophylactic antibiotics in nonoperative facial fractures. J Craniofac Surg. 2016;27(7):1677–80.CrossRefPubMedGoogle Scholar
  19. 19.
    Wladis EJ. Are post-operative oral antibiotics required after orbital floor fracture repair? Orbit. 2013;32(1):30–2.Google Scholar
  20. 20.
    Mundinger GS, Borsuk DE, Okhah Z, Christy MR, Bojovic B, Dorafshar AH, Rodriguez ED. Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice. Craniomaxillofac Trauma Reconstr. 2015;8(1):64–78.CrossRefPubMedGoogle Scholar
  21. 21.
    Zix J, Schaller B, Iizuka T, Lieger O. The role of postoperative prophylactic antibiotics in the treatment of facial fractures: a randomised, double-blind, placebo-controlled pilot clinical study. Part 1: orbital fractures in 62 patients. Br J Oral Maxillofac Surg. 2013;51(4):332–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Nichols RL. Surgical antibiotic prophylaxis. Med Clin North Am. 1995;79(3):509–22.CrossRefPubMedGoogle Scholar
  23. 23.
    Burnakis TG. Surgical antimicrobial prophylaxis: principles and guidelines. Pharmacotherapy. 1984;4:248–71.CrossRefPubMedGoogle Scholar
  24. 24.
    Carter SR, Stewart JM, Khan J, Archer KF, Holds JB, Seiff SR, Dailey RA. Infection after blepharoplasty with and without carbon dioxide laser resurfacing. Ophthalmology. 2003;110(7):1430–2.CrossRefPubMedGoogle Scholar
  25. 25.
    Fay A, Nallasamy N, Bernardini F, Wladis EJ, Durand ML, Devoto MH, et al. Multinational comparison of prophylactic antibiotic use for eyelid surgery. JAMA Ophthalmol. 2015;133(7):778–84.CrossRefPubMedGoogle Scholar
  26. 26.
    Rietschel RL, Fowler JF Jr, editors. Fisher’s contact dermatitis. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2001.Google Scholar
  27. 27.
    Fay A, Nallasamy N, Pemberton JD, Callahan A, Wladis EJ, Nguyen J, Durand ML, New England Oculoplastics Society Study Group. Prophylactic postoperative antibiotics for enucleation and evisceration. Ophthal Plast Reconstr Surg. 2013;29(4):281–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Walland MJ, Rose GE. Soft tissue infections after open lacrimal surgery. Ophthalmology. 1994;101(3):608–11.CrossRefPubMedGoogle Scholar
  29. 29.
    Vardy SJ, Rose GE. Prevention of cellulitis after open lacrimal surgery: a prospective study of three methods. Ophthalmology. 2000;107(2):315–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Ali MJ, Ayyar A, Motukupally SR, Sharma S, Naik MN. Bacteremia during dacryocystorhinostomy: results of intra-operative blood cultures. J Ophthalmic Inflamm Infect. 2014;4:27.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Pinar-Sueiro S, Fernández-Hermida RV, Gibelalde A, Martínez-Indart L. Study on the effectiveness of antibiotic prophylaxis in external dacryocystorhinostomy: a review of 697 cases. Ophthal Plast Reconstr Surg. 2010;26(6):467–72.CrossRefPubMedGoogle Scholar
  32. 32.
    Yazici B, Meyer DR. Selective antibiotic use to prevent postoperative wound infection after external dacryocystorhinostomy. Ophthal Plast Reconstr Surg. 2002;18(5):331–5.CrossRefPubMedGoogle Scholar
  33. 33.
    JL LR Jr, Rees TD, Nolan WB. Infections requiring hospital readmission following face lift surgery: incidence, treatment, and sequelae. Plast Reconstr Surg. 1994;93(3):533–6.CrossRefGoogle Scholar
  34. 34.
    Stacey DH, Warner JP, Duggal A, Gutowski KA, Marcus BC. International interdisciplinary rhytidectomy survey. Ann Plast Surg. 2010;64(4):370–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Beeson WH, Rachel JD. Valacyclovir prophylaxis for herpes simplex virus infection or infection recurrence following laser skin resurfacing. Dermatol Surg. 2002;28(4):331–6.PubMedGoogle Scholar
  36. 36.
    Gilbert S, McBurney E. Use of valacyclovir for herpes simplex virus-1 (HSV-1) prophylaxis after facial resurfacing: a randomized clinical trial of dosing regimens. Dermatol Surg. 2000;26(1):50–4.CrossRefPubMedGoogle Scholar
  37. 37.
    Perkins SW, Sklarew EC. Prevention of facial herpetic infections after chemical peel and dermabrasion: new treatment strategies in the prophylaxis of patients undergoing procedures of the perioral area. Plast Reconstr Surg. 1996;98(3):427–33. discussion 434–5CrossRefPubMedGoogle Scholar
  38. 38.
    Bisaccia E, Scarborough D. Herpes simplex virus prophylaxis with famciclovir in patients undergoing aesthetic facial CO2 laser resurfacing. Cutis. 2003;72(4):327–8.PubMedGoogle Scholar
  39. 39.
    Nestor MS. Prophylaxis for and treatment of uncomplicated skin and skin structure infections in laser and cosmetic surgery. J Drugs Dermatol. 2005;4(6 Suppl):s20–5.PubMedGoogle Scholar

Suggested Readings

  1. Levison ME, Levison JH. Pharmacokinetics and pharmacodynamics of antibacterial agents. Infect Dis Clin N Am. 2009;23(4):791–815.CrossRefGoogle Scholar
  2. Brook I. Microbiology of sinusitis. Proc Am Thorac Soc. 2011;8(1):90–100.CrossRefPubMedGoogle Scholar
  3. Eye disorders. Merck Manuals Professional Edition. N.p., n.d. Web. 4 Feb 2017.Google Scholar
  4. Mukherjee B, Raichura ND, Alam MS. Fungal infections of the orbit. Indian J Ophthalmol. 2016;64(5):337–45.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Blaser MJ. Missing MIcrobes. Holt and Co. 2014.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Jean-Paul J. Abboud
    • 1
  • Natalie Homer
    • 2
  • Aaron Fay
    • 3
  1. 1.Ophthalmic Plastic and Reconstructive SurgeryWest Virginia University Eye InstituteMorgantownUSA
  2. 2.Department of OphthalmologyMassachusetts Eye and Ear Infirmary, Harvard Medical SchoolBostonUSA
  3. 3.Department of OphthalmologyHarvard Medical SchoolFitchburgUSA

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