Tobiflamin is a fixed-dose combination of tobramycin 3 mg/mL and dexamethasone 1 mg/mL in the form of eye drops. Tobramycin is a bactericidal antibiotic of the aminoglycoside group, effective in the treatment of superficial eye infections caused by Gram-positive staphylococci, streptococci, and Gram-negative bacteria such as Escherichia coli, Acinetobacter, Citrobacter, Haemophilus influenzae, Moraxella, and Klebsiella. The additional presence of 0.1% dexamethasone in the eye drops provides an anti-inflammatory effect, reducing tissue swelling and the local autoimmune process in the conjunctiva triggered by bacterial death and the release of their proteins, i.e., toxins. Tobiflamin is successfully used in children aged 1 year and older and in adults.

The vast majority of patients seen in an ophthalmologist’s outpatient clinic are those with acute conjunctivitis and blepharitis (Cagini C., Mariniello M. et al., 2020). Conjunctivitis is common in young children (3–5 years old), which is associated with attending preschool and poor hygiene habits at home. The spectrum of bacterial flora in children most often includes staphylococci, Moraxella, Haemophilus influenzae, and Escherichia coli. If the use of two medications in the form of eye drops is indicated, it is very important for young patients that both active ingredients are in a single bottle, as each instillation may be met with resistance and irritation from the child. The drug Tobiflamin rapidly exhibits bactericidal and anti-edema effects, which usually allows for the complete cure of bacterial conjunctivitis within 5 days.
In adults, blepharoconjunctivitis occurs due to an exacerbation of the saprophytic microflora of the Meibomian glands or infection with aggressive strains of streptococci, Enterobacter, pneumococci, and Pseudomonas aeruginosa via contact-household or airborne transmission. Administering Tobiflamin every 3 hours provides a potent bactericidal and anti-inflammatory effect on the eyelids and conjunctiva. During clinical examination of patients treated with Tobiflamin, a reduction in swelling and redness of the eyelid margins and conjunctiva, as well as the absence of exudate and pus, is observed as early as after the first three instillations; the patient experiences a reduction in burning and eye discomfort, and mucous discharge from the conjunctiva disappears 4–6 hours after starting Tobiflamin.
The presence of bacterial flora in the sebaceous secretions of the eyelid margins causes chronic blepharitis, which manifests as thickening and discomfort at the eyelid margins, insufficient secretion of sebum onto the eye surface, and a sensation of dryness and a foreign body in the eye. Inflammatory processes in the conjunctiva are inextricably linked to the function of the Meibomian glands and the sebaceous glands of the eyelashes, which often results in the formation of chalazia within the eyelid tissue (Wu A.Y., Gervasio K.A., 2019). Tobiflamin is effective for the treatment of chronic and acute blepharoconjunctivitis, as tobramycin is bactericidal against the typical bacterial flora of the eyelids: Staphylococcus aureus, Staphylococcus epidermidis, and Enterobacter aerogenes. Restoration of sebaceous secretion flow promotes rapid cleansing of the eyelid margins from scales and residual inflammatory exudate. Short-term use of dexamethasone in Tobiflamin for 5–7 days is safe with regard to increased intraocular pressure and cataractogenesis.
Congenital nasolacrimal duct obstruction occurs in 6–12% of newborns; by the age of 1 year, it resolves spontaneously in 85% of cases with sac massage or duct irrigation. However, in some children, the obstruction persists into the second year of life; this clinical situation requires combined treatment with eye drops and probing of the nasolacrimal duct. It is precisely the fixed combination of an antibiotic and a corticosteroid in a single vial that will facilitate treatment for young patients and improve treatment compliance. Probing of the nasolacrimal duct is best performed several days after using tobramycin/dexamethasone drops, which will destroy the bacterial flora in the duct and lacrimal sac and reduce swelling of the duct walls (Qin Xiang, Dan Hu, Xu Gao, 2019).
Acute episcleritis and scleritis are isolated ocular syndromes and may also be typical manifestations of systemic autoimmune diseases: rheumatoid arthritis, seronegative spondylitis, and juvenile rheumatoid arthritis. Episcleritis and scleritis manifest as superficial or deep pericorneal or scleral injection, ciliary pain, and swelling of the ocular tissues. When encountering scleritis for the first time or episkleritis, an ophthalmologist may not immediately determine the etiology of the process: whether the nature of this clinical case is bacterial or autoimmune. The first-line treatment is a combination of tobramycin and dexamethasone, as this allows for the elimination of the bacterial component on the conjunctiva and the cessation of the inflammatory process in the superficial and deep layers of the sclera (Wang J., Zhang Q. et al., 2022). Rapid recovery is ensured by a fixed combination of tobramycin and dexamethasone; instillations are administered every 3 hours into the affected eye for 7–10 days.
Children with juvenile idiopathic arthritis (JIA) constitute a distinct patient group in whom systemic disease onset occurs between the ages of 3 and 5 years and is accompanied by inflammation in one or both eyes. Ocular manifestations of JIA consist of scleritis and episcleritis, as well as anterior and posterior uveitis. The first-line treatment upon detection of uveitis or scleritis in a child is the use of a fixed combination of tobramycin and dexamethasone for 5–7 days (Kraus C.L., Culican S.M., 2012). In the absence of improvement in the eye and the persistence of inflammatory processes in the joints, the issue of prescribing immunobiological therapy should be addressed.
Adults develop anterior or posterior uveitis between the ages of 30 and 50; the risk group consists of HLA-B27-positive men with seronegative spondylitis. Anterior uveitis in such patients recurs 1–2 times a year, especially in cases of immune system decompensation and the inability to use immunobiological therapy. However, in 50% of cases, anterior uveitis is an isolated clinical syndrome: there is no systemic pathology or association between uveitis and arthritis. Acute pain and redness in one eye are accompanied by decreased vision. The situation is complicated by the deposition of cellular precipitates on the corneal endothelium and the anterior lens capsule, which undergo prolonged natural resorption. Treatment with the combination drug Tobiflamin should begin on the first day of uveitis and be administered actively (every 2 hours for the first 5 days; subsequently, the frequency of instillations can be reduced to 4 times per day). Dexamethasone 0.1% in Tobiflamin penetrates well into the anterior chamber of the eye and stops the inflammatory process in the iris and ciliary body.
Surgical interventions for cataracts, glaucoma, and the removal of pterygium and chalazia are indications for the use of the combination of tobramycin and dexamethasone. Primary wound healing occurs due to the bactericidal effect of the aminoglycoside tobramycin, while dexamethasone helps reduce swelling and inflammation at the wound margins. Following surgical procedures, the duration of Tobiflamin use is 5–7 days.
Tobiflamin is not used during pregnancy and lactation. The drug is well tolerated; according to the literature, side effects in the form of mild eye redness were observed in less than 1% of patients

Thus, the fixed combination of tobramycin and dexamethasone in Tobiflamin eye drops is effective and safe for children aged 1 year and older and adults for many conditions and during the postoperative period.