Maxitrol (neomycin 0.35%, polymyxin B, dexamethasone 0.1%)

Neomycin sensitization: Cutaneous sensitization may occur, ranging from local effects to erythema, itching, urticaria, skin rash, anaphylaxis, anaphylactoid reactions, or bullous reactions; discontinue if hypersensitivity develops.

Aminoglycoside cross-sensitivity: Sensitization to the topical aminoglycoside may extend to other topical or systemic aminoglycosides.

Periocular contact allergy: In a German patch test series of periorbital dermatitis, allergic contact dermatitis was the leading cause (44.3% and 31.6% across two cohorts) and neomycin sulfate ranked among the five most relevant allergens at 8%.

Prolonged corticosteroid use: Glaucoma with optic nerve damage, defects in visual acuity and fields of vision, and posterior subcapsular cataract formation.

Host response suppression: Prolonged use increases the hazard of secondary ocular infection, and prolonged topical antibacterial use may allow overgrowth of non-susceptible organisms including fungi; suspect fungal invasion in any persistent corneal ulceration where a corticosteroid has been used, and culture when appropriate.

Infection masking: Acute purulent or parasitic ocular infection may be masked or its activity enhanced by corticosteroid.

Herpes simplex exacerbation: Ocular steroids may prolong the course and worsen many viral eye infections; treating a patient with a history of herpes simplex requires great caution and frequent slit lamp microscopy.

Corneal and scleral thinning: Ocular disease and long-term topical corticosteroids thin these tissues, and use over thin cornea or sclera may lead to perforation.

IOP monitoring at 10 days: Routine monitoring is required with use of 10 days or longer, including in children and uncooperative patients; use with caution in glaucoma and check IOP frequently.