Doxycycline in the management of pseudomonas corneal melting: two case reports and a review of the literature.

BACKGROUND: Pseudomonas keratitis can result in the breakdown of collagen with subsequent corneal melting and perforation. The use of antimetalloproteinases may help to stabilize melting and prevent imminent perforation of the cornea. The use of topical protease inhibitors and neutrophil inhibitors is of limited value. Tetracyclines, however, have been shown to have anticollagenolytic activity and inhibit metalloproteinases, and they may suppress connective tissue breakdown.

PURPOSE: To establish the stabilization of corneal melting in cases of Pseudomonas keratitis.

METHODS: Two young patients with severe contact lens-associated Pseudomonas keratitis and corneal melting were treated with oral doxycycline and standard topical treatment.

RESULTS: Corneal melting was stabilized in each patient, and perforation was avoided.

CONCLUSIONS: Tetracyclines have an anticollagenolytic action in addition to their antimicrobial activity. The use of doxycycline as an adjunctive therapy in the management of Pseudomonas corneal melting may help to stabilize corneal breakdown and prevent subsequent perforation.