Which medication combination is used for severe CLARE as described?

Which medication combination is used for severe CLARE as described?

• A. Ciprofloxacin 0.3% with Prednisolone 1% qid
• B. Tobramycin-Dexamethasone 0.3/0.1% qid
• C. Neomycin-Polymyxin B qid
• D. Moxifloxacin 0.5% qid

Answer: (B)

Managing severe CLARE hinges on addressing both the inflammatory reaction and the risk of bacterial infection from contact lens wear. A fixed combination that delivers both an antimicrobial and a corticosteroid is preferred because it quickly reduces corneal inflammation while providing broad-spectrum coverage against common lid- and lens-related pathogens, including Pseudomonas. The tobramycin-dexamethasone combination fits this need: tobramycin covers a wide range of Gram-negative bacteria, and dexamethasone dampens the inflammatory response that drives the severe signs in CLARE. Dosing four times daily maintains effective levels to control inflammation and infection concurrently, which is crucial in severe cases. The other options lack either the anti-inflammatory component or the appropriate spectrum in a single preparation. Antibiotics alone won’t quell the inflammatory infiltrates, and a fluoroquinolone with a steroid is not the standard fixed regimen described for severe CLARE.

Managing severe CLARE hinges on addressing both the inflammatory reaction and the risk of bacterial infection from contact lens wear. A fixed combination that delivers both an antimicrobial and a corticosteroid is preferred because it quickly reduces corneal inflammation while providing broad-spectrum coverage against common lid- and lens-related pathogens, including Pseudomonas.

The tobramycin-dexamethasone combination fits this need: tobramycin covers a wide range of Gram-negative bacteria, and dexamethasone dampens the inflammatory response that drives the severe signs in CLARE. Dosing four times daily maintains effective levels to control inflammation and infection concurrently, which is crucial in severe cases.

The other options lack either the anti-inflammatory component or the appropriate spectrum in a single preparation. Antibiotics alone won’t quell the inflammatory infiltrates, and a fluoroquinolone with a steroid is not the standard fixed regimen described for severe CLARE.