What topical and systemic treatment options are most effective for infectious bovine keratoconjunctivitis?

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Antibiotic therapy is the cornerstone of infectious bovine keratoconjunctivitis (IBK) treatment, and most antibiotic treatments show improved healing compared to placebo, with the largest treatment differences observed 7–14 days post-treatment.9 Topical antibiotic application is the primary route for corneal and conjunctival bacterial infections in cattle, with subconjunctival injection offering a depot effect as a practical alternative in large animals.7 Topical treatment with ciprofloxacin ophthalmic solution has been used successfully in naturally occurring IBK, with corneal re-epithelialization achieved within 30 days and clinical resolution by 45 days in reported cases.1 Topical acetylcysteine and homologous serum have been used adjunctively alongside topical antibiotics in the same protocol.1 Once corneal re-epithelialization is confirmed and antibiotic therapy is discontinued, topical dexamethasone can be continued to address residual inflammation.1 Subconjunctival injection is rated as a highly effective treatment by practitioners, and in Australian farmer surveys it ranked among the treatments most frequently rated as highly effective alongside injectable antibiotics, ophthalmic ointments, and eye patches.3 Eye patches are used as an adjunct to reduce UV exposure and fly irritation, and fly control is an established component of IBK management.3 Non-antimicrobial treatment alternatives remain at a preliminary stage of investigation. Topical application of Bdellovibrio bacteriovorus ophthalmic solution was not effective for treatment of corneal ulcers under experimental conditions.5 Fly control measures have shown efficacy for IBK prevention in most studies evaluated, making them the best-supported non-antimicrobial intervention currently available.8 Vaccines — both autogenous and commercial — have not demonstrated consistent efficacy in blinded randomized field trials.6 Early identification and treatment are essential to minimize pain, prevent progression t