Treatment of Experiemental Pseudomonas Keratitis with Cyclo-oxygenase and Lipoxygenase Inhibitors

The role of metabolites of arachidonic acid in experimental Pseudomonas keratitis was studied using inhibitors of arachidonic acid metabolism. Nordihydroguaiaretic acid 1%, which inhibits predominantly the lipoxygenase pathway, and flurbiprofen 0.03%, which inhibits predominantly the cyclo-oxygenase pathway were administered topically to rabbit eyes after intrastromal injection of Pseudomonas aeruginosa. Levels of the cyclo-oxygenase product prostaglandin E2 (PGE2) and the lipoxygenase product leukotriene B4, (LTB4) were measured, and the number of ulcers that had progressed to descemetocele formation by 24 hours was determined. Corneal ulceration was accelerated by flurbiprofen, but nordihydroguaiaretic acid limited the flurbiprofen-induced worsening. The use of flurbiprofen was associated with decreased levels of PGE2 and a relative increase in LTB4, a potent chemoattractant and activator of polymorphonuclear leukocytes. These results suggest that inhibition of the cyclooxygenase pathway may be contraindicated in Pseudomonas keratitis; inhibition of lipoxygenase can prevent this worsening of the keratitis.