Dexaron® Plus (Eye/Ear Drops & Ointment): A Guide to the Triple-Action Formula

MEDICAL INFORMATION: Dexaron® Plus is a prescription-only ophthalmic/otic medicine. The following is educational and not a substitute for professional medical advice. Use only under a doctor’s supervision after proper diagnosis. Incorrect use may worsen infections or cause complications.

Dexaron® Plus (Eye/Ear Drops & Ointment): Triple-Action Corticosteroid + Dual Antibiotics

Summary

Dexaron® Plus (Amoun, Egypt) combines a potent corticosteroid (dexamethasone) with two broad-spectrum antibiotics (neomycin and polymyxin B) to manage steroid-responsive inflammatory conditions of the eye or external ear when bacterial infection is present or suspected. It targets inflammation, pain, and likely bacterial pathogens simultaneously. Use is short-term and monitored.

Category & Active Ingredients

• Category: Ophthalmic/Otic corticosteroid + antibiotics combination.
• Actives: Dexamethasone; Neomycin sulfate; Polymyxin B sulfate.

Available Forms & Pack Sizes

• Eye/Ear Drops (suspension): plastic dropper bottle, ~5 mL.
• Eye/Ear Ointment: tube, ~5 g.
• *Note: Exact concentrations may vary by market batch/leaflet; always check the pack insert you dispense.

How It Works (Mechanism)

1. Dexamethasone: Suppresses inflammatory mediators → reduces redness, swelling, pain, cellular exudate.
2. Neomycin (aminoglycoside): Bactericidal; inhibits protein synthesis—active vs many Gram-negative and some Gram-positive organisms.
3. Polymyxin B: Bactericidal; disrupts bacterial cell membrane—especially effective vs Pseudomonas aeruginosa and other Gram-negatives.

Indications

• Ocular: Steroid-responsive inflammatory conditions of palpebral/bulbar conjunctiva, cornea, and anterior segment where bacterial infection exists or risk of infection is high (e.g., postoperative inflammation with suspected bacterial component).
• Otic: External otitis (otitis externa) when inflammation coexists with suspected/confirmed bacterial infection and intact tympanic membrane.

Dosage & Administration

Use exactly as prescribed. Shake drops well before each use.

• Eye/Ear Drops: 1–2 drops into affected eye(s) or ear(s) up to 4× daily; in severe cases, dosing may be more frequent initially then tapered by the physician.
• Ophthalmic Ointment: Thin ribbon in conjunctival sac up to 3× daily; commonly used at bedtime with daytime drops.
• Duration: Short courses are preferred. Prolonged use only under close monitoring (IOP checks, corneal status).
• Tapering: Do not stop abruptly after high-frequency use; prescriber may taper to prevent rebound inflammation.

Contraindications

• Hypersensitivity to dexamethasone, neomycin, polymyxin B, or formulation excipients.
• Ocular viral infections (e.g., herpes simplex keratitis—dendritic ulcer), vaccinia, varicella.
• Ocular mycobacterial or fungal infections.
• Otic: Perforated tympanic membrane (risk of ototoxicity from aminoglycosides/polymyxin).

Warnings & Precautions

• Intraocular Pressure (IOP): Prolonged steroid use can elevate IOP → glaucoma, optic nerve damage; monitor if >10 days.
• Corneal/ scleral thinning & delayed healing: Risk of perforation, especially in disease with corneal thinning.
• Masking/Worsening infection: Steroids may mask clinical signs; monitor for non-response or superinfection (incl. fungi).
• Contact lenses: Avoid wearing contact lenses during active ocular infection/inflammation; preservatives can discolor soft lenses.
• Cross-contamination: Do not use the same bottle for eye and ear simultaneously; avoid touching tip to eye/ear/skin.
• Allergic sensitization: Neomycin may cause contact sensitization; discontinue if hypersensitivity occurs.

Side Effects

• Ocular: Transient burning/stinging, blurred vision, photophobia; with longer use: elevated IOP, posterior subcapsular cataract, delayed wound healing, secondary infection.
• Otic: Local irritation, itching; with membrane breach risk of ototoxicity (hearing/balance issues).
• Allergy: Lid itching, redness, periocular dermatitis; neomycin sensitization possible.

Drug Interactions

• Other topical ocular steroids: Additive risk of ↑IOP, cataract, delayed healing.
• Topical/systemic aminoglycosides: Additive risk of hypersensitivity/ototoxicity (otic setting).
• Live vaccines (systemic context): Not typically relevant to short topical use; systemic immunosuppression minimal but caution with prolonged/high-frequency use.

Use in Special Populations

• Pregnancy: Systemic absorption from topical ocular/otic use is low; use only if potential benefit justifies potential risk—limit duration.
• Breastfeeding: Unlikely to affect infant at ophthalmic/otic doses; minimize exposure and duration.
• Pediatrics: Higher susceptibility to steroid effects (↑IOP, adrenal suppression if prolonged). Use the lowest effective dose for the shortest time with monitoring.
• Elderly: Monitor IOP and corneal integrity closely.
• Hepatic/Renal impairment: Clinically significant systemic exposure is low; standard precautions apply.

How to Use (Technique)

• Eye drops: Wash hands → shake bottle → tilt head back → pull lower lid → instill drop without touching tip → close eye and press inner canthus 1–2 min (nasolacrimal occlusion) to reduce systemic absorption.
• Ophthalmic ointment: Apply a thin ribbon to lower conjunctival sac → close eye gently for 1–2 min.
• Ear drops: Clean/ dry external canal; for adults pull pinna up/back; instill drops; keep head tilted ~2–3 min.
• Separate from other eye meds by ≥5–10 minutes (drops before ointment).

Monitoring & When to Seek Care

• No improvement or worsening after 48–72 hours → reassess; consider culture/sensitivity.
• Longer than 10 days of ocular use → check IOP periodically.
• Stop and seek urgent care if severe pain, sudden vision changes, marked swelling, rash, or signs of hypersensitivity occur.

Storage & Handling

• Store at room temperature per leaflet; protect from excessive heat; do not freeze.
• Keep bottle/tube tightly closed; avoid contaminating the tip.
• Discard drops 28 days after opening (common practice unless the leaflet states otherwise).
• Keep out of reach of children.

FAQ

Why must the drops be shaken? They are a suspension; shaking ensures accurate dosing.

Can I use it for any “red eye”? No. Steroid drops can worsen herpes or fungal keratitis. Always use after proper diagnosis.

How long can I use it? Short courses only; prolonged use requires close medical follow-up (IOP checks, infection surveillance).

Can I wear contact lenses? Avoid during active infection/inflammation and while using preserved drops.

References

1. DailyMed: Neomycin/Polymyxin B/Dexamethasone ophthalmic products (prescribing information).
2. American Academy of Ophthalmology (AAO): Patient guidance on red eye, keratitis, and steroid risks.
3. Amoun Product Leaflet: Local pack insert for Dexaron® Plus (consult latest version with the dispensed pack).