Chloramphenical Eye Drops During Pregnancy

[Nell799]

I have an infective ulcer on my eye, and am 35 weeks pregnant.

I had one last year, and it became very bad and I ended up having to put in drops every hour day and night for four days, and then could cut out the night time drops. Involved several visits to the hospital.

This time it isnt as bad. However, the opthamologist treating me couldnt really find any data on whether the drops are safe during pregnancy, so I checked with the pharmasist, who also couldnt find any information, so they sent me across to the GP. I didnt get a chance to speak with the GP. The receptionist took my perscription to them and came back saying it was fine.

However, I have 'Googled' and all the articles say not to use during pregnancy because the drops can not be broken down by a babies liver. Even the NHS website said not to use during pregnancy. You can have Chloramphenical is other ways, and if you have it via an IV it can cause 'Greys Syndrome' in unborn babies, so I dont know whether this is just a precaution and eye drops are fine, and to just trust the doctor. But I am worried and am not sure what to do.

[MrBloomsNursery]

I had an eye infection when pregnant with DD and was prescribed chloramphenicol eyedrops. It's only an antibiotic, so surely can't be that dangerous? What is the dosage you are taking? I mean, approximately, how many mgs per drop are you taking?

[PrincessPoppySeed]

As an Optometrist, I was under the impression Chloramphenicol eye drops are safe in pregnancy. It's about the only thing that is! However, I agree that Google doesn't look positive about it.

Err...are they sure it is an infective ulcer? You really do need treatment if it is and I wouldn't have thought that chloramphenicol is enough. Although that depends on how bad it is. Were you confident in the Ophthalmologist who diagnosed you?

Sorry, this isn't necessarily helpful....

One helpful thing if you decide you need to the drops. Only put in one drop in the eye and then close your eye and press the corner of your eye near your nose. This is to close the puncta, where the drop will drain away from. This is where the systemic absorption happens. You want it to go into your eye, where it will be effective and not affect the baby.

[Nell799]

Its not the same drops I used last year, in fact I think I had two types last time, but they did say it was a tiny ulcer caught early and not like the one I had last year. It also doesnt feel as bad or painful, or look as sore so I think they were right. I have to go back Monday to have it re checked.

[PrincessPoppySeed]

I would do the chloramphenicol then - 4 times a day, is it? Just be sure to do punctal occlusion everytime.

For ulcers we would generally use stronger and more specific antibiotics, but if it's small chloramphenicol will hopefully do the job.

Glad it's being rechecked on Monday - if it's any worse then they can take the appropriate action.

[Nell799]

Its every two hours. I did put it in the cornor of my eye and could taste it straight away. I didnt realise.

[PrincessPoppySeed]

Yes, so that is disappearing down your nose and the back of your throat. Pull the bottom eyelid out and drop it in there and push hard on the corner of your eye to close the punctum drainage.

Hope it heals ok.

[BustAMove]

Hi, I got prescribed these by my doctor in the last trimester. It was only the pharmacist who, actually came running down the street after me, to say that I should def not be taking them (she had not realised I was pregnant until one of the shop staff told her), she then led me back and showed me in her big book why I couldn't take them. Now I'm sure it caused something called, grey baby syndrome, or similar??? Anyway, I wasn't that bothered by what it caused, because I was never going to use them after that. So, I wouldn't use them no.

[BustAMove]

sorry, yes, just looked on wiki, is gray baby syndrome. Although seems quite rare, and maybe you would need to have quite a high dose?? but, I wouldn't risk it.

[Nell799]

It says in the leaflet not to use , and on the nhs knowledge base says topical application during last few weeks may cause gray baby syndrome so I dare not use them . Going to the out of hours doctors tomorrow to chat about it as also dare not leave the ulcer untreated .

[sharond101]

I am a Pharmacist and am under no circumstances able to offer them to a pregnant lady. Not seen any Doctors prescribe them either. There is a risk of gray baby syndrome and they are not given to young infants for this reason either.

[PIMSoclock]

Hiya. The toxbase review of all the studies say that chloramphenicol used topically has not been associated with an increased risk of congenital abnormalities. It acknowledges that systemic use of chloramphenicol has been linked to grey baby syndrome but there was only ever one published case of this in 1971. There have been studies showing normal outcomes (no greys) even with chloramphenicol exposure.
The neonatal blood concentration required to cause greys is 5mcg of drug per ml of blood.
The conc of drug in the drops is 0.25mg per drop. Only a tiny amount of this would be adsorbed systemically and would be diluted by the mothers 3.5 ltr blood volume before any was passed to baby. Some studies have found no trace of chloramphenicol in the urine of children who have had 2 hourly drops. The amount absorbed systemically is negligible.
It would be impossible to cause a worrying foetal blood concentration from eye drops alone.
If there is no other alternative that is completely safe in preg, it doesn't look like this is a particularly risky alternative.
Hth