Bacterial infection caused by Francisella tularensis acquired from animals or insect bites
Your form affects the eye and nearby lymph nodes
Not contagious person-to-person; your family is safe
Your medications
Take all antibiotic doses exactly as prescribed (10-21 days depending on antibiotic)
Do not stop antibiotics early even if you feel better; relapse is common with incomplete courses
Ciprofloxacin: take with plenty of water; avoid dairy products or antacids within 2 hours
Doxycycline: take with full glass of water; stay upright for 30 minutes after dose; avoid sun exposure
Eye care at home
Artificial tears for discomfort 4-6 times daily
Cool compresses to eye for swelling
Do not touch or rub your eye
Wear sunglasses outdoors if sensitive to light
Follow-up appointments
Ophthalmology appointment within 48-72 hours for eye check
Return to your doctor in 1-2 weeks to confirm improvement
Repeat blood test (serology) may be needed at 2-4 weeks
Return to emergency department immediately for
Worsening eye pain, vision changes, or new eye symptoms
Increasing swollen lymph node size, redness, or drainage from node
Persistent or recurrent fever after 48-72 hours of antibiotics
New cough, chest pain, or shortness of breath
Confusion, severe headache, or neck stiffness
Prevention for the future
Wear gloves when handling wild animals or carcasses
Use insect repellent (DEET) and perform tick checks after outdoor activities
Do not drink untreated water from streams or ponds in endemic areas
Avoid rubbing eyes after handling animals or working outdoors
References
Guidelines and key sources
Primary guidelines and landmark references
Nelson CA et al. Tularemia Antimicrobial Treatment and Prophylaxis: CDC Recommendations for Naturally Acquired Infections and Bioterrorism Response - United States, 2025. MMWR. 2025. PMID: 41026652
2025 CDC MMWR guidelines: fluoroquinolones and doxycycline as first-line for tularemia
Maurin M, Gyuranecz M. Tularaemia: Clinical Aspects in Europe. Lancet Infect Dis. 2016. PMID: 26738841
Comprehensive clinical review including oculoglandular form epidemiology and outcomes
Dennis DT, Inglesby TV, Henderson DA et al. Tularemia as a Biological Weapon: Medical and Public Health Management. JAMA. 2001
Landmark bioterrorism preparedness guidelines for F. tularensis
Maurin M, Pondérand L, Hennebique A et al. Tularemia Treatment: Experimental and Clinical Data. Front Microbiol. 2023. PMID: 38298538
Comprehensive treatment evidence review including MIC data and relapse rates
Antonello RM, Giacomelli A, Riccardi N. Tularemia for Clinicians: An Up-to-Date Review on Epidemiology, Diagnosis, Prevention and Treatment. Eur J Intern Med. 2025. PMID: 40107886
2025 comprehensive clinician-focused review
Copur B, Surme S. Water-Borne Oculoglandular Tularemia: Two Complicated Cases and a Review of the Literature. Travel Med Infect Dis. 2022. PMID: 36334909
Oculoglandular-specific review with complication data and timeline to diagnosis
Ho BM, Davis HE, Forrester JD et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Management of Tick-Borne Illness in the United States. Wilderness Environ Med. 2021
WMS tick-borne illness guidelines including tularemia management
CDC Tickborne Diseases of the United States: A Reference Manual for Healthcare Providers, 6th Edition. 2022
Comprehensive tick-borne disease reference including tularemia
Weber IB, Turabelidze G, Patrick S et al. Clinical Recognition and Management of Tularemia in Missouri: A Retrospective Records Review of 121 Cases. CID. 2012. PMID: 22911645
Large US case series informing epidemiology and clinical features
Adalja AA, Toner E, Inglesby TV. Clinical Management of Potential Bioterrorism-Related Conditions. NEJM. 2015
Bioterrorism framework for tularemia and other Category A agents
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.