<PAGE>



EXHIBIT 10.10

                        SIXTH AMENDMENT TO LOAN AGREEMENT

         THIS SIXTH AMENDMENT ("Amendment") made this 18th day of June, 2002
between MEDICAL ACTION INDUSTRIES INC., a Delaware corporation, having its
principal place of business at 800 Prime Place, Hauppauge, New York 11788 (the
"Borrower") and CITIBANK, N.A., having an office at 730 Veterans Memorial
Highway, Hauppauge, New York 11788 (the "Bank").

                              W I T N E S S E T H :

         WHEREAS, the Borrower and the Bank entered into a Loan Agreement dated
as of the 18th day of March, 1999, which Loan Agreement has heretofore been
amended pursuant to that certain First Amendment dated as of September 1, 1999,
that certain Second Amendment dated as of June 28, 2000, that certain Third
Amendment dated as of October 10, 2000, that certain Fourth Amendment dated as
of November 10, 2000 and that certain Fifth Amendment dated as of November 28,
2001 (as so amended, the "Agreement"); and

         WHEREAS, the Bank has made loans to the Borrower as evidenced by
certain notes of the Borrower and specifying interest to be paid thereon; and

         WHEREAS, the Borrower has requested that the Bank:

              (i) increase the Commitment for Revolving Credit Loans to Thirteen
Million ($13,000,000.00) Dollars;

              (ii) amend the Borrowing Base; and

              (iii) amend certain financial covenants contained in the
Agreement.

         NOW, THEREFORE, in consideration of Ten ($10.00) Dollars and other good
and valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the Borrower, the Guarantors and the Bank do hereby agree as
follows:

         1. Defined Terms. As used in this Amendment, capitalized terms, unless
otherwise defined, shall have the meanings set forth in the Agreement.

         2. Representations and Warranties. As an inducement for the Bank to
enter into this Amendment, the Borrower and each Guarantor represents and
warrants as follows:

              A. That with respect to the Agreement and the Loan Documents
executed in connection therewith and herewith:



                                       31
<PAGE>

              (i) There are no defenses or offsets to the Borrower's or any
         Guarantor's obligations under the Agreement as amended hereby, the Note
         or any of the Loan Documents or any other agreements in favor of the
         Bank referred to in the Agreement, and if any such defenses or offsets
         exist without the knowledge of the Borrower or any Guarantor, the same
         are hereby waived.

              (ii) All of the representations and warranties made by the
         Borrower and any Guarantor in the Agreement as amended hereby are true
         and correct in all material respects as if made on the date hereof,
         except for those made with respect to a particular date, which such
         representations and warranties are restated as of such date; and
         provided further that the representations and warranties set forth in
         Section 4.01(f) of the Agreement shall relate to the financial
         statements of the Borrower for the fiscal year ended March 31, 2002.

         4. New and Amended Definitions. (a) The following definition is hereby
added to the Agreement:

              "AMENDED AND RESTATED REVOLVING CREDIT NOTE" means a promissory
              note of the Borrower payable to the order of the Bank, in
              substantially the form of Exhibit A annexed to the Sixth Amendment
              to this Agreement, evidencing the aggregate indebtedness of the
              Borrower to the Bank resulting from Revolving Credit Loans made by
              the Bank to the Borrower pursuant to this Agreement.

              (b) The following definitions contained in the Agreement are
hereby amended to read as follows:

              "BORROWING BASE" means the sum of eighty (80%) of the Borrower's
              Eligible Accounts Receivable, plus (ii) the lesser of (x) fifty
              five (55%) percent of the Borrower's Eligible Inventory or (y)
              $8,000,000.00.

              "NOTE" OR "NOTES" means the Term Loan Note, the Amended and
              Restated Revolving Credit Note, the Term Loan II Note or any or
              all of the same as the context may require.

              "REVOLVING CREDIT MATURITY DATE" means March 31, 2004.

         5. Amendments. (a) Section 2.08 of the Agreement is hereby amended to
read as follows:


                                       32
<PAGE>

              "SECTION 2.08. THE REVOLVING CREDIT LOANS. The Bank agrees, on the
              date of this Agreement, on the terms and conditions of this
              Agreement and in reliance upon the representations and warranties
              set forth in this Agreement, to lend to the Borrower prior to the
              Revolving Credit Maturity Date such amounts as the Borrower may
              request from time to time (individually, a "Revolving Credit Loan"
              or collectively, the "Revolving Credit Loans"), which amounts may
              be borrowed, repaid and reborrowed; provided, however, that the
              aggregate amount of such Revolving Credit Loans plus L/C Exposure
              plus B/A Exposure outstanding at any one time shall not exceed the
              lesser of (i) Thirteen Million ($13,000,000.00) Dollars (the
              "Commitment"), or (ii) the Adjusted Borrowing Base, or such lesser
              amount of the Commitment as may be reduced pursuant to Section
              2.14 hereof.

              Each Revolving Credit Loan shall be a Prime Rate Loan or a
              Eurodollar Loan (or a combination thereof) as the Borrower may
              request subject to and in accordance with Section 2.09. The Bank
              may at its option make any Eurodollar Loan by causing a foreign
              branch or affiliate to make such Loan, provided that any exercise
              of such option shall not affect the obligation of the Borrower to
              repay such Loan in accordance with the terms of the Revolving
              Credit Note. Subject to the other provisions of this Agreement,
              Revolving Credit Loans of more than one type may be outstanding at
              the same time."

              (b) Section 2.10 of the Agreement is hereby amended to read as
follows:

              "SECTION 2.10. AMENDED AND RESTATED REVOLVING CREDIT NOTE. Each
              Revolving Credit Loan shall be (i) in the case of each Prime Rate
              Loan, in the minimum principal amount of $100,000.00, and in
              minimum increased multiples of $50,000.00, and (ii) in the case of
              each Eurodollar Loan, in the minimum principal amount of
              $1,000,000.00 and in minimum increased multiples of $100,000.00
              (except that, if any such Prime Rate Loan so requested shall
              exhaust the remaining available Commitment, such Prime Rate Loan
              may be in an amount equal to the amount of the remaining available
              Commitment). Each Revolving Credit Loan shall be evidenced by the
              Amended and Restated Revolving Credit Note of the Borrower. The
              Amended and Restated Revolving Credit Note shall be dated the date
              of the Sixth Amendment to this Agreement and be in the principal
              amount of Thirteen Million ($13,000,000.00) Dollars, and shall
              mature on the Revolving Credit Maturity Date, at which time the
              entire outstanding principal balance and all interest thereon
              shall be due and payable. The Amended and Restated



                                       33
<PAGE>

              Revolving Credit Note shall be entitled to the benefits and
              subject to the provisions of this Agreement.

              At the time of the making of each Revolving Credit Loan and at the
              time of each payment of principal thereon, the holder of the
              Amended and Restated Revolving Credit Note is hereby authorized by
              the Borrower to make a notation on the schedule annexed to the
              Amended and Restated Revolving Credit Note of the date and amount,
              and the type and Interest Period of the Revolving Credit Loan or
              payment, as the case may be. Failure to make a notation with
              respect to any Revolving Credit Loan shall not limit or otherwise
              affect the obligation of the Borrower hereunder or under the
              Amended and Restated Revolving Credit Note with respect to such
              Revolving Credit Loan, and any payment of principal on the Amended
              and Restated Revolving Credit Note by the Borrower shall not be
              affected by the failure to make a notation thereof on said
              schedule."

              (c) Section 2.11 of the Agreement is hereby amended to read as
follows:

              "SECTION 2.11. PAYMENT OF INTEREST ON THE AMENDED AND RESTATED
              REVOLVING CREDIT NOTE. (a) In the case of a Prime Rate Loan,
              interest shall be payable at a rate per annum equal to the Prime
              Rate. Such interest shall be payable on each Interest Payment
              Date, commencing with the first Interest Payment Date after the
              date of such Prime Rate Loan and on the Revolving Credit Maturity
              Date. Any change in the rate of interest on the Amended and
              Restated Revolving Credit Note due to a change in the Prime Rate
              shall take effect as of the date of such change in the Prime Rate.

                   (b) In the case of a Eurodollar Loan, interest shall be
              payable at a rate per annum equal to the Reserve Adjusted LIBOR
              Rate plus the LIBOR Applicable Margin. Such interest shall be
              payable on each Interest Payment Date, commencing with the first
              Interest Payment Date after the date of such Eurodollar Loan and
              on the Revolving Credit Maturity Date. In the event Eurodollar
              Loans are available, the Bank shall determine the rate of interest
              applicable to each requested Eurodollar Loan for each Interest
              Period at 11:00 a.m., New York City time, or as soon as
              practicable thereafter, two (2) Business Days prior to the
              commencement of such Interest Period and shall use its best
              efforts to notify the Borrower of the rate of interest so
              determined. Such determination shall be conclusive absent manifest
              error."



                                       34
<PAGE>

              (d) The first sentence of Section 5.01 of the Agreement is hereby
amended to read as follows:

              "SECTION 5.01. AFFIRMATIVE COVENANTS. So long as any amount shall
              remain outstanding under the Term Loan II Note, the Revolving
              Credit Note or the Amended and Restated Revolving Credit Note, or
              so long as the Commitment shall remain in effect, the Borrower
              will, unless the Bank shall otherwise consent in writing:"

              (e) The first sentence of Section 5.02 of the Agreement is hereby
amended to read as follows:

              "SECTION 5.02. NEGATIVE COVENANTS. So long as any amount shall
              remain outstanding under the Term Loan II Note, the Revolving
              Credit Note or the Amended and Restated Revolving Credit Note, or
              so long as the Commitment shall remain in effect, the Borrower
              will not, without the written consent of the Bank:"

              (f) Section 5.02(d) of the Agreement is hereby amended to read as
follows:

              "(d) Merger. Merge into, or consolidate with or into, or have
              merged into it, any Person; and, for the purpose of this
              subsection (d), the acquisition or sale by the Borrower by lease,
              purchase or otherwise, of all, or substantially all, of the common
              stock or the assets of any Person or of it shall be deemed a
              merger of such Person with the Borrower other than in connection
              with Permitted Acquisitions, provided that the total aggregate
              consideration (whether cash, stock or assumed liabilities) for all
              Permitted Acquisitions (not including the acquisition of the
              medical products division of Acme United Corp., certain assets of
              Medi-Flex Products, Inc. or the acquisition of MD Industries)
              shall not exceed $2,000,000.00 in any fiscal year or $5,000,000.00
              in the aggregate during the term of this Agreement."

              (g) The first sentence of Section 5.03 of the Agreement is hereby
amended to read as follows:

              "SECTION 5.03. FINANCIAL REQUIREMENTS. So long as any amount shall
              remain outstanding under the Revolving Credit Note, the Amended
              and Restated Revolving Credit Note or the Term Loan II Note or so
              long as the Commitment shall remain in effect:"

              (h) Section 5.03(a) of the Agreement is hereby amended to read as
follows:

                                       35
<PAGE>

              "(a) Minimum Capital Base. The Borrower will maintain at all
              times, to be tested as of each fiscal quarter end, a minimum
              Capital Base of not less than the following:

              Period                                 Minimum Capital Base
              ------                                 --------------------

              3/31/01 to 3/30/03                        $ 7,000,000.00
              3/31/03 to 3/30/04                        $12,000,000.00
              3/31/04 and thereafter                    $17,000,000.00"

              (i) Section 5.03(b) of the Agreement is hereby amended to read as
follows:

              "(b) Maximum Cash Flow Leverage Ratio. The Borrower will maintain
              at all times a maximum Cash Flow Leverage Ratio of not less than
              the following, to be tested quarterly (i) on an annualized basis
              during the period ending December 31, 2002, and (ii) on a rolling
              four quarter basis for each fiscal year thereafter:


                                                       Maximum Cash Flow
               Period                                    Leverage Ratio
               ------                                    --------------

               3/31/01 to 3/30/03                        3.50 to 1.0
               3/31/03 to 3/30/04                        2.00 to 1.0
               3/31/04 and thereafter                    1.50 to 1.0"

              (j) Section 6.01(a) of the Agreement is hereby amended to read as
follows:

              "(a) The Borrower shall fail to pay any installment of principal
              of, or interest on, the Term Loan Note, the Term Loan II Note, the
              Revolving Credit Note or the Amended and Restated Revolving Credit
              Note when due or any fees or other amounts owed in connection with
              this Agreement; or"

              (k) Section 6.01(d) of the Agreement is hereby amended to read as
follows:

              "(d) The Borrower or any Subsidiary of the Borrower shall fail to
              pay any Debt (excluding Debt evidenced by the Term Loan Note, the
              Term Loan II Note, the Revolving Credit Note and the Amended and
              Restated Revolving Credit Note) of the Borrower or any such
              Subsidiary (as the case may be), or any interest or premium
              thereon, when due (whether by scheduled maturity, required

                                       36
<PAGE>

              prepayment, acceleration, demand or otherwise) and such failure
              shall continue after the applicable grace period, if any,
              specified in the agreement or instrument relating to such Debt; or
              any other default under any agreement or instrument relating to
              any such Debt, or any other event shall occur and shall continue
              after the applicable grace period, if any, specified in such
              agreement or instrument, if the effect of such default or event is
              to accelerate, or to permit the acceleration of, the maturity of
              such Debt; or any such Debt shall be declared to be due and
              payable, or required to be prepaid (other than by a regularly
              scheduled required prepayment), prior to the stated maturity
              thereof; or"

              (l) Section 6.02 of the Agreement is hereby amended to read as
follows:

              "SECTION 6.02. REMEDIES ON DEFAULT. Upon the occurrence and
              continuance of an Event of Default the Bank may by notice to the
              Borrower, (i) terminate the Commitment, (ii) declare the Term Loan
              Note, the Term Loan II Note, the Revolving Credit Note, the
              Amended and Restated Revolving Credit Note, all interest thereon
              and all other amounts payable under this Agreement to be forthwith
              due and payable, whereupon the Commitment shall be terminated, the
              Term Loan Note, the Term Loan II Note, the Revolving Credit Note,
              the Amended and Restated Revolving Credit Note, all such interest
              and all such amounts shall become and be forthwith due and
              payable, without presentment, demand, protest or further notice of
              any kind, all of which are hereby expressly waived by the
              Borrower, and (ii) proceed to enforce its rights whether by suit
              in equity or by action at law, whether for specific performance of
              any covenant or agreement contained in this Agreement or any Loan
              Document, or in aid of the exercise of any power granted in either
              this Agreement or any Loan Document or proceed to obtain judgment
              or any other relief whatsoever appropriate to the enforcement of
              its rights, or proceed to enforce any other legal or equitable
              right which the Bank may have by reason of the occurrence of any
              Event of Default hereunder or under any Loan Document, provided,
              however, upon the occurrence of an Event of Default referred to in
              Section 6.01(e), the Commitment shall be immediately terminated,
              the Term Loan Note, the Term Loan II Note, the Revolving Credit
              Note, the Amended and Restated Revolving Credit Note, all interest
              thereon and all other amounts payable under this Agreement shall
              be immediately due and payable without presentment, demand,
              protest or further notice of any kind, all of which are hereby
              expressly waived by the Borrower. Any amounts collected pursuant
              to action taken under this Section 6.02 shall be applied to the
              payment of, first, any costs incurred by



                                       37
<PAGE>

              the Bank in taking such action, including but without limitation
              attorneys fees and expenses, second, to payment of the accrued
              interest on the Term Loan Note, the Term Loan II Note, the
              Revolving Credit Note and the Amended and Restated Revolving
              Credit Note,, and third, to payment of the unpaid principal of the
              Term Loan Note, the Term Loan II Note, the Revolving Credit Note
              and the Amended and Restated Revolving Credit Note,."

              (m) Section 7.04 of the Agreement is hereby amended to read as
follows:

              "SECTION 7.04. COSTS, EXPENSES AND TAXES. The Borrower agrees to
              pay on demand all costs and expenses of the Bank in connection
              with the preparation, execution, delivery and administration of
              this Agreement, the Term Loan II Note, the Revolving Credit Note,
              the Amended and Restated Revolving Credit Note and any other Loan
              Documents, including, without limitation, the fees and expenses of
              counsel for the Bank with respect thereto and with respect to
              advising the Bank as to its rights and responsibilities under this
              Agreement, and all costs and expenses, if any (including counsel
              fees and expenses), in connection with the enforcement of this
              Agreement, the Term Loan II Note, the Revolving Credit Note, the
              Amended and Restated Revolving Credit Note and any other Loan
              Documents. The Borrower shall at all times protect, indemnify,
              defend and save harmless the Bank from and against any and all
              claims, actions, suits and other legal proceedings, and
              liabilities, obligations, losses, damages, penalties, judgments,
              costs, expenses or disbursements which the Bank may, at any time,
              sustain or incur by reason of or in consequence of or arising out
              of the execution and delivery of this Agreement and the
              consummation of the transactions contemplated hereby. The Borrower
              acknowledges that it is the intention of the parties hereto that
              this Agreement shall be construed and applied to protect and
              indemnify the Bank against any and all risks involved in the
              execution and delivery of this Agreement and the consummation of
              the transactions contemplated hereby, all of which risks are
              hereby assumed by the Borrower, including, without limitation, any
              and all risks of the acts or omissions, whether rightful or
              wrongful, of any present or future de jure or de facto government
              or governmental authority, provided that the Borrower shall not be
              liable for any portion of such liabilities, obligations, losses,
              damages, penalties, actions, judgments, suits, costs, expenses or
              disbursements resulting from the Bank's gross negligence or
              willful misconduct. The provisions of this Section 7.04 shall
              survive the payment of the Notes and the termination of this
              Agreement."

                                       38
<PAGE>

              (n) Section 7.05 of the Agreement is hereby amended to read as
follows:

              "SECTION 7.05. RIGHT OF SET-OFF. Upon the occurrence and during
              the continuance of any Event of Default, the Bank is hereby
              authorized at any time and from time to time, to the fullest
              extent permitted by law, to set off and apply any and all deposits
              (general or special, time or demand, provisional or final) at any
              time held and other indebtedness at any time owing by the Bank, or
              any affiliate of the Bank, to or for the credit or the account of
              the Borrower or any Guarantor against any and all of the
              obligations of the Borrower or any Guarantor now or hereafter
              existing under this Agreement, the Term Loan Note, the Term Loan
              II Note, the Revolving Credit Note and the Amended and Restated
              Revolving Credit Note, irrespective of whether or not the Bank
              shall have made any demand under this Agreement, the Term Loan
              Note, the Term Loan II Note, the Revolving Credit Note or the
              Amended and Restated Revolving Credit Note and although such
              obligations may be unmatured. The rights of the Bank under this
              Section are in addition to all other rights and remedies
              (including, without limitation, other rights of set-off) which the
              Bank may have."

              (o) Section 7.10 of the Agreement is hereby amended to read as
follows:

              "SECTION 7.10. GOVERNING LAW. This Agreement, the Term Loan Note,
              the Term Loan II Note, the Revolving Credit Note, the Amended and
              Restated Revolving Credit Note and all other Loan Documents shall
              be governed by, and construed in accordance with, the laws of the
              State of New York."

         7. Conditions Precedent to the Effectiveness of this Amendment. The
obligation of the Bank hereunder is subject to the condition precedent that the
Bank shall have received from the Borrower the following, in form and substance
satisfactory to the Bank and its counsel:

              (a) The Amended and Restated Revolving Credit Note duly executed
              and payable to the order of the Bank.

              (b) Certified (as of the date of the Sixth Amendment to this
              Agreement) copies of the resolutions of the Board of Directors of
              the Borrower authorizing Amended and Restated Revolving Credit
              Note and authorizing and approving the Sixth Amendment to this
              Agreement and the other Loan Documents and the execution, delivery
              and performance thereof and certified copies of all



                                       39
<PAGE>

              documents evidencing other necessary corporate action and
              governmental approvals, if any, with respect to the Sixth
              Amendment to this Agreement and the other Loan Documents.

              (c) A certificate of the Secretary or an Assistant Secretary
              (attested to by another officer) of the Borrower certifying: (i)
              the names and true signatures of the officer or officers of the
              Borrower authorized to sign the Sixth Amendment to this Agreement,
              the Amended and Restated Revolving Credit Note and the other Loan
              Documents to be delivered hereunder on behalf of the Borrower; and
              (ii) a copy of the Borrower's by-laws as complete and correct on
              the date of the Sixth Amendment to this Agreement.

              (d) Copies of the certificate of incorporation and all amendments
              thereto of the Borrower, certified by the Secretary of State (or
              equivalent officer) of the state of incorporation of the Borrower
              and a certificate of existence and good standing with respect to
              the Borrower from the Secretary of State (or equivalent officer)
              of the state of incorporation of the Borrower and from the
              Secretary of State (or equivalent officer) of any state in which
              the Borrower is authorized to do business.

              (e) An opinion of Richard G. Satin, Esq., counsel for the Borrower
              as to certain matters referred to in Article IV of the Agreement
              and as to such other matters as the Bank or its counsel may
              reasonably request.

              (f) A Commitment Fee equal to $9,500.00.

              (g) All schedules, documents, certificates and other information
              provided to the Bank pursuant to or in connection with the Sixth
              Amendment to this Agreement shall be satisfactory to the Bank in
              all respects.

              (i) The following statements shall be true and the Bank shall have
              received a certificate signed by the President or principal
              accounting officer of the Borrower dated the date of the Sixth
              Amendment to this Agreement, stating that:

                   (i) The representations and warranties contained in Article
              IV of the Agreement and in the Loan Documents are true and correct
              on and as of such date; and

                   (ii) No Default or Event of Default has occurred and is
              continuing, or would result from the increase in the Commitment
              contemplated hereby.



                                       40
<PAGE>

              (h) All legal matters incident to the Sixth Amendment to this
              Agreement and the Loan transactions contemplated hereby shall be
              satisfactory to Cullen and Dykman, LLP, counsel to the Bank.

              (i) The Bank shall have received evidence that the Borrower has
              closed the acquisition of MD Industries, Inc.

              (j) Receipt by the Bank of such other approvals, opinions or
              documents as the Bank or its counsel may reasonably request.

              (k) The Borrower shall have paid the reasonable fees and
              disbursements of the Bank's counsel, Cullen and Dykman, LLP in
              connection with this Sixth Amendment to the Agreement."

         8. Governing Law. This Amendment shall be governed by, and construed in
accordance with, the laws of the State of New York.

         9. Counterparts. This Amendment may be executed in any number of
counterparts and by different parties hereto in separate counterparts, each of
which when so executed shall be deemed to be an original and all of which taken
together shall constitute one and the same agreement.

         10. Ratification. Except as hereby amended, the Agreement and all other
Loan Documents executed in connection therewith shall remain in full force and
effect in accordance with their originally stated terms and conditions. The
Agreement and all other Loan Documents executed in connection therewith, as
amended hereby, are in all respects ratified and confirmed.

         IN WITNESS WHEREOF, the parties hereto have executed this Amendment as
of the year and date first above written.



  MEDICAL ACTION INDUSTRIES INC.                     CITIBANK, N.A.



  By:/s/ Paul D. Meringolo                           By:/s/ Richard Romano
     ----------------------------------                 -----------------------
       President                                        Group Vice President



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