Warning about "disappearing" preservatives

[Natalie06]

I have been using Theratears now for months since my Lasik surgery. I use the "becomes preservative on contact" for the convenience but just read an article that this can actually be toxic if your eyes don't have enough tears in them to disolve the preservative when it does make contact. Thanks goodness for the internet. My MD never mentioned this possibility but it does make sense. There are days when it seems like the more I use the tears, the more I need them and the worse my lid margins feel.

Here is the link if anyone else is interested. I for one am going to go back to totally preservative free for at least a month to see if that helps.

http://www.revoptom.com/index.asp?Ar...esson_0201.htm


By the way, the derm I saw Monday agrees with my Lasik surgeon's diagnosis of rosacea.

Have a great day.

Natalie

[Judy]

Hello Natalie06,

Wow, incredible article. Thanks so much for sharing the link! Best of luck with your rosacea!!

[kakinda]

Hi Nathalie
yes do keep us posted on that, thanks for the article.
Here's an important quote: "The same may happen with the “disappearing” preservative found in many brands of artificial tears. The disappearing preservative, often borate or hydrogen peroxide, dissolves from H2O2 to H2O when it comes in contact with tears, but many patients lack sufficient tears to dissolve the preservative. H2O2 can be toxic to an already compromised cornea.
However, tears with the disappearing preservative are ideal for patients without signifi- cant keratoconjunctivitis sicca and who have moderate tear production sufficient to dissolve the preservative. These brands combine convenience and cost-savings, two factors that usually increase compliance. Clinically, they appear to be a better choice than preserved tears in regards to preservative build-up and toxicity, so long as the patient has sufficient tears to dissolve the preservative."

I'm always amazed by what some people seem to call progress. In this case, these are eye-drops for frequent use in patients who lack tears (otherwise they wouldn't buy them, right?) but then to use this safely you must have enough tears to dissolve them. So i guess this is meant for very mild DE sufferer who desire to get... worse.
Therefore be sure to have enough tears to cope with your treatment...
Well I'm sorry but this doens't seem very logical to me. When are they going to sell us water in powder (just add the water!) or some silly thing like that.
Maybe a good suggestion for the labs would be buy additional unpreserved drops to cope with the consequences of preserved ones... even if dissipating ones are less abrasive. Ok less harm done than with usual preservative but still let's be logical, let's get out of this dead-end issue, go preservative free.

[Judy]

Hi kakinda,

So seriously, what preservative-free eyedrops do you use? I was just getting started with the Systane Free eyesdrops when the recall occurred. I use Refresh Plus, but using them 15 to 20 times a day is a bit much. Any others that help you more? Refresh Endura blurred my eyes and didn't feel very comfortable either so I stopped those fairly rapidly... Thanks for any input on this subject! Judy

[kakinda]

anyone heard of Viva drops?

I use Artelac, Celluvisc, Vismed, and lots of saline besides anti-histaminic eye drops.
Used to use: Hylocomod, Blink, Lacryvisc
I think some of these are available in the US now

has anyone tried these:

http://www.visionpharm.com/prodfeat.html

[Judy]

Thanks, Kakinda,

I'll research some of these in the US! Have a GREAT DAY!!

[calli66]

Well, FINALLY- a discussion about those "preservatives disappearing in the eye!" I always had the feeling that otc drops depend on at least a minimum amount of "normal" tears to work. I have a Schirmer score of 2-3, and have had burning and irritation from most drops---preserved and unpreserved. The Systane brand is especially weird in my eyes--the drops go in and soak up the small amount of moisture in my eyes--and the "drops" become solidified irritants.

C66

[Randal]

Which Antihistamine Drops?

I use Artelac, Celluvisc, Vismed, and lots of saline besides anti-histaminic eye drops.
Used to use: Hylocomod, Blink, Lacryvisc
I think some of these are available in the US now

has anyone tried these:

http://www.visionpharm.com/prodfeat.html

Kakinda:

You mentioned antihistamine drops. Which brands do you use? The only ones I ever see over-the-counter contains preservatives, usually BAK.

Thanks.

Randal

[Lucy]

For preservative-free drops in the single vial, I've had best luck with TheraTears, followed by Refresh Plus. I have tried just about everything available, but keep coming back to these. They are also the most widely available.

NOTE: I still use Dr. Holly's drops and like them all, mostly NutraTear. While dealing with my Boston Scleral Lens especially I need something preservative-free. This is for ME - I don't know about anyone else.

Lucy

[kakinda]

Kakinda:

You mentioned antihistamine drops. Which brands do you use? The only ones I ever see over-the-counter contains preservatives, usually BAK.

Thanks.

Randal

I use Zaditen (zaditor in the US) and Almide (Alomide) in the US, main active substance: ketitofen fumarate and lodoxamide...
the other are not available in the US. Sorry...
not that effective either but no preservative. I just talked to THE expert in this area in France and he hopes we'll have new unpreserved options within one year that could include PF versions of mild steroid in combination with other things (I'm not supposed to disclose more than this).
This is an important aspect of unmet needs in OSD care, one which is frequently overlooked.
So some hope soon...

[AccutaneJay]

First, thank-you to the person who posted the initial article.

IMO, preserved drops are for the birds, and even the disappearing preservative drops are only for very occasional use if the severity of your condition is not severe. Even the TheraTears web-site outlines that their multi-use bottled drops are...

"For eyes with mild or moderate dryness that need only occasional or maintenance treatment."

I think that anyone with even moderate dry eye should not be picking up any preserved or disappearing preservative-like drops until they are only requiring light maintenance, as outlined above. In fact, I think you're better off just simply always using unpreserved drops if possible - we owe it to ourselves and our eyes to only provide the best treatment option possible that we can afford.

I personally only use unpreserved TheraTears in vial form.

On a somewhat similar note: logic tells me that if a drop burns or is uncomfortable even the least bit upon instillation, it is not acceptable to be putting in your eye. You have to ask yourself "does a drop burn or irritate your eye upon being instilled?" and then ask yourself "why do you think that is?" For me, TheraTears is the only drop I can put in that does not irritate, burn, or become uncomfortable after instillation, so I know it is the best out there for me.

[cibi78]

I only use unpreserved vials for both allergy and KCS now. I'm amazed to see that doctors don't tell you more about this. That it can cause problems to your eyes and without even noticing them at first you keep on like this. Until a good doctor tells you "stop". Suddenly, you're better. Not fine but better. Less irritations.

bye,
cibi78

[sazy123]

I'm always amazed by what some people seem to call progress. In this case, these are eye-drops for frequent use in patients who lack tears (otherwise they wouldn't buy them, right?) but then to use this safely you must have enough tears to dissolve them. So i guess this is meant for very mild DE sufferer who desire to get... worse.
Therefore be sure to have enough tears to cope with your treatment...

My sentiments exactly! i really fail to see the point in them wasting time on artificial tears like this which IMO are actualy POINTLESS and of no help to moderate-severe dry eye sufferers. Ok they might help those with mild dry eye but so would many other brands/single vial or safe preserved tears. My eyes go from mild-severe depending on my face pain and IMHO i dont even need to use artificial tears at all when my eyes are mild- they serve no purpose becoz my eyes are dry but dont bother me, SO in this case i see them as pointless!unless its for dry contacts. sorry this sort of thing just really enoys me