Adverse Outcomes Associated with Unscrupulous Ocular Use of Topical Chloramphenicol: A Case Report and Brief Review of Literature

Topical chloramphenicol is a broad-spectrum, cost-effective antibiotic commonly used for superficial ocular and eyelid infections, especially in the low- and middle-income countries. However, despite its efficacy, its use should be judicious, particularly in the context of safer alternatives and known risks. While in countries like the United States, chloramphenicol is reserved for select cases where first-line treatments are contraindicated, its widespread availability and over-the-counter use in resource-limited settings raise safety concerns. This report presents two unique cases highlighting previously undocumented adverse effects of the topical chloramphenicol. In Case 1, a patient developed irritant contact dermatitis localized to the eyelids, while Case 2 demonstrated ocular surface toxicity restricted to the site of application. In both cases, symptoms resolved following prompt discontinuation of the drug. These presentations underscore the importance of recognizing subtle, yet significant side effects such as lower lid conjunctival hyperaemia or periorbital desquamation, which may otherwise be overlooked. Given the potential for both local and systemic toxicity—including in vulnerable populations such as infants, pregnant or lactating women—this report advocates for greater clinical caution. Furthermore, it emphasizes the urgent need for updated regulatory oversight to curb its over-the-counter availability and promote rational antibiotic use. Considering sparse and outdated literature, this brief review contributes valuable insights, reinforcing the necessity of vigilance in prescribing chloramphenicol ointment.