Eyedrops with preservatives

[robster]

Since my dry eye problems started last year I have used four different types of eye drops/gels. Blink preservative free, Celluvisc(preservative free), Systane and Clinitas Hydrate Gel.

The Blink preservative free was next to useless in providing any relief so I have not used it in over 6 months. I hardly use the Celluvisc drops during the day due to it being so thick. The main things I use on my eyes are Systane drops during the day and Clinitas Hydrate gel at night. I was told the Systane drops were preservative free and have since found they are not and also that the Clinitas Gel has preservatives in.

I'm a bit worried as i've heard people on this forum say that preservative free drops are better for your eyes. My question is why are preservative free drops better for your eyes and have I caused any damage to my eyes by using products with preservatives in for the last 6 months?

Thanks for any help.

[hirentherock]

Well you are getting just too much worried.Do not worry for the preservatives you have used till now.Usually they are not that much harmful unless used for long term.The Problem with preservatives is that many of the people are allergic to one of the substances present in the preservative composition. Drops do give relief in dry eyes but you might notice some relief if you use preservative free drops compared to drops with preservatives.I read here many people are allergic to BAK.

If you believe my case, i have been using eye drops since age of 8 years and now im 30!!!All the drops i used till now are with preservatives.I tried preservative free vials in 2002-03 times but i didnt find much of a difference.Then i had been on genteal eye drops for past 7 years and im okay with it.Its also not preservative free.They didnt have prestv free drops till now.

And i have improved a lot in all these years.I would want to give the preservative free drops a try again.Lets see in near future. all the best

[Colin P]

Robster! Are you using the Celluvisc 1% which i agree is the closest thing to a gel. As there is also a Celluvisc (also Preservative free) 0.5% which is a drop and no thicker than any other brand, costs approx £9.99 for a box of 30 Vials...
And as for single use, then throw away; why do all maufacturers vials have replaceable caps, but say throw away once opened?.
Dont quote me, but i use them for 24hrs EACH... I snap one open last thing at night, then snap the cap back on and use it next day- new one 24hrs later.
One manufaturer [Rohto] even say do the above, as there preservative free vials are good for 24hrs each once opened.

ps, Rohto did not work for me...

[robster]

I've been using the 1% Celluvisc, I've also got a box of the 0.5% Celluvisc which my clinic sent me a week ago but I have yet to use them. Will definitely give them a try over the weekend as I'm finding the 1% Celluvisc drops a bit thick for day time use.

Apart from allergies are there any other reasons why you shouldn't use drops & gels with preservatives in?

[Colin P]

Im sure ive read, also been advised a few times now Rob, that the preservative option is for short term use as the preservative that is used will be damaging to your eyes for long term use.
I am willing to stand corrected(*said the man in the orthopedic shoes) if this is not the case..


I found 'Hylo-tear' aka 'hyloforte' to be a good preservative free drop Rob. Which is available on prescription, otherwise it's £20...

[robster]

Thanks Colin. Does anyone know in what way are preservative drops bad for your eyes? How exactly do they damage the eyes?

[lulu]

Benzalkonium Chroride tends to disrupt the integrity of the goblet cells on the cornea, if used in the long term. There is a lot of literature out there, I have read a few paper's in my time and they all seem to come to the same conclusion. BAK is the one that is often quoted but I have come across some fairly leary ones myself. Asda sold an eye mist which absoulutely drove my eyes nuts and on closer inspection I discovered that one of the ingredients turned to formeldehyde in the eye! This took a bit of digging but it was clearly the culprit as all the other ingredients I have used in the past with no problems.
If you like celluvisc than that is fine, I found that in the long term the CMC made my eyes drier, but I dont think it has a dodgy profile at the same level as BAK. I know one site really does not like it and I have spoken to lots of folk who hate the "plastic" residue left on the eye lashes which just irritates. I think it depends on just how dry your eyes are, I could use it for the first couple of years but in the end, it was very counterproductive. You can get systane pf vials as I know the little bottle has a mild preservative in it, this was quite problematic for me and I used to love systane pf vials but can no longer use them either. I use blink pf vials and cyclosporin ointment but to be honest they are not that great but my eyes are so much worse now. You could try clinitas soothe pf vials? or clinitas ultra 3 which lots of people really swear have helped thier eyes return to pre dryness levels. (Naturally of course, I was seriously sensitive to the ultra 3) I do use the soothe on occasions and it has the highest concentration of sodium hylauronate at 4%.
Hyloforte which Colin mentioned is pretty inoffensive too.
I think that there are some preservative's which are genuinely harmful to the eye in the long term but most of the milder one's will make the eye feel uncombtable if you are the sort of person to tend to have a reaction to drops, huge number's of people never have any problems.
Lulu

[littlemermaid]

We are doing well on saline Minims sodium chloride 0.9% (plus Hylotears sometimes, in case the hyaluronic acid is healing the surface damage - handy PF delivery bottle). I also follow what Spectrum Thea are making (eg first to exclude phosphates). Minims feel good from the fridge especially if the eyes are inflamed.

[robster]

Thanks for your replies Lulu and Little Mermaid. None of the items I am using have BAK in thankfully. I am definitely going to give the Hylotears and Clinits Ultra 3 a try.

One finally thing the Systane drops(the ones I use most) have a 0.001% preservative which is Polidronium Chloride(Polyquad). At such a low concentration are these preservatives able to do my eyes any harm if I continue to use them long term?

[littlemermaid]

Robster, If I was thinking about this I'd start by looking at the DEWS Report 2007 again http://www.tearfilm.org/dewsreport/, page 165 'preservatives' which mentions Polyquad and others and explains some of the action, then maybe a PubMed search to see if anyone's done specific research, maybe US FDA guidelines in case they have a view. Has anyone got better information?

Preservatives in eyedrops: the Good, the Bad and the Ugly, Baudouin, C et al. Prof B's team are looking at this for us, PubMed 'Baudouin C' (careful with spelling!). They consider 'active ingredient + preservative + excipient (inactive carrier)' for eyedrops and the effect on different parts of the eye, so it's not just preservatives. The effects may be allergic, toxic or inflammatory. Also important for glaucoma patients.

'On the basis of all these experimental and clinical reports, it would be advisable to use benzalkonium-free solutions whenever possible, especially in patients with the greatest exposure to high doses or prolonged treatments, in those suffering from preexisting or concomitant ocular surface diseases, and those experiencing side effects related to the ocular surface. Indeed, mild symptoms should not be underestimated, neglected, or denied, because they may very well be the apparent manifestations of more severe, potentially threatening subclinical reactions that may later cause major concerns.'

I wish I had had more common sense on this and didn't have to rely on docs so much. We are doing fine on saline Minims but I would be happier if LM would wear wraparounds all day to help restore the surface, esp on the computer.

[lulu]

Polyquads have a safer profile than BAKs. However, according to some studies they do have a tendency to cause some minor disruption to the corneal cells. I beleive I read once and I will have to check for this, that they can reduce the density of the goblet cells?? I think that this was it, I will look for it. I remember reading that the polyquads were detergent based and had first been used in sterilisation of lenses. With any chemical that has a preservative action and has to guard against bacteria, it is not surprising that it will have some effect on the sensitive corneal nerve endings, let alone the cells themselves.
You could probably use mild preservatives for some time and be okay, but I tend to think its better to keep it simple and go for pf vials. Try systane vials if you like systane, they have no mild preservative's in them.
Lulu

[SunshineinCalgary]

Could you tell me how many times do you use drops per day on average? And do you use Restasis on top of this?

I can do fairly well in the day time with 4-5 times Systane Ultra. But evening is worst and I have problems driving with eye pain and irritation. Thanks.

[adienich]

Useful thread, as I've been wondering about the same thing lately. I used to use preservative free vials of a brand of drops that was available in Europe, but I can't get those now that I live in the U.S. Had some problems finding something that really worked but then I found Systane Balance. That has so far been the best for me, works even better than the drops I used earlier. I don't think Systane Balance is available as preservative free, it only seems to come in the bottle and does have polyquad in it. Regular Systane or Systane Ultra did not seem to help at all, so I can't use those. If anyone does find more information on the effects of polyquad, I'd be grateful too.

[robster]

Thanks to everyone for there responses. Got my clinic to send me various preservative free drops to try. Like Lulu said I'm going to keep it simple, play it safe and just stick with PF drops.