Dry Eye and Borate Buffered Solutions?

[Blinks]

Hi, DEZ folks,

I'm new to this group! Things are not going very well, so I'm in research mode...and I am so very grateful to find this community.

I suffer from corneal scarring, astigmatism, dry eye, have had superficial keratectomy in both eyes, and, years ago, had Grave's with exophthalmos. Currently I'm trying out "medically necessary" contacts for improved vision which eyeglasses can't fix. I've found an article via Google which may be of interest though a bit of a challenge: "Corneal epithelial cell biocompatibility to silicone hydrogel and conventional hydrogel contact lens packaging solutions" published Feb. 2010. Authors: Gorbet, Tanti, Jones, Sheardown.

Conclusions: "Borate-buffered packaging solutions were shown to adversely affect the viability and integrin expression of HCECs in vitro. When used in ophthalmic packaging solutions, the antimicrobial properties of borate buffer may be outweighed by its relatively cytotoxic effects on cells. "

It was a tough slog to read, but it makes a case that disposable lenses (including Acuvue) stored in borate-buffered packaging (like Unisol) reduces epithelial cell viability and shows lenses packed in phosphate buffered solutions don't kill as many corneal epithelial cells. This is my layman's interpretation so I could be drawing conclusions inappropriately.

I've been dispensed Acuvue Moist (packed in borate buffered solution), have been using recommended Refresh Tears (Boric Acid listed first in "inactive ingredients"), with Unisol (boric acid buffered) to rinse eyes in the morning, and Unisol dispensed into GP lenses (piggy back) on top of Acuvues.

My eyes have been increasingly dry and painful, resulting in more frequent application of artificial tears (sometimes every 20 minutes), shorter lens wearing time (2-3 hours max), and increased dryness. Gee. The day I woke up with cloudy vision and really painful eyes, I stopped wearing the lenses.

Is this a significantly greater exposure to boric acid than what has been studied? Could the boric acid be killing off the epithelial cells causing pain and dryness? (I've stopped wearing the lenses, stopped the Refresh Tears, and switched to Tears Naturale II which lists Borate near the end of the list of the inactive ingredients) and I plan to discuss with my doc at upcoming appointment.

I'm looking into hybrids, but wonder about the use of saline (Unisol again) in the reservoirs as this seems to be at least equal to the exposure listed in the study mentioned above. My goal is to be able to see better but not at the expense of more damage to the already scarred corneas.

Thank you for the chance to vent and for any suggestions or thoughts on alternatives to the boric acid buffering. Has anyone had similar issues traced to boric acid or borate buffered solutions or lenses?

Blinks

[Blinks]

Hi,

Recently I discovered Refresh Plus Lubricant Eye Drops (single use, preservative free) which does not have borate or boric acid listed in the ingredients.

This is my second day with these drops. So far there's been improvement and marked relief from the burning sensation caused by the dry eyes. It's early days, but the first time I used the Refresh Plus drops, my eyes felt soothed.

So far, I've not experienced the stinging or burning that I had with the use of the Refresh Tears (green bottle), a formula which lists boric acid first on the list of inactive ingredients.

I have Salzmann's corneal nodular dystrophy. Not sure if this is caused by the dry eye and past history of wearing contact lenses, or if the dry eye is the result of severe scarring which creates more surface area, and limited tear production. Maybe there's a vicious cycle going on with the Salzmann's that causes recurrence after each superficial keratectomy.

Anyway, I'm trying to avoid solutions and drops containing borate and boric acid to see if this may provide relief and will post progress again.

There's another fairly recent study describing the cytotoxic effect of borate buffered solutions on corneal epithelial cells which I found via Google: "Effect of contact lens material on cytotoxicity potential of multipurpose solutions using human corneal epithelial cells" Authors: L. Jones, from Dept of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada (December 2011, Molecular Vision).

Based on these two studies, (the first one mentioned in my original post) my working theory, as a layperson with no science background, is this: my daily use of
1) dispensing three drops of saline solution buffered with borate into GP lenses prior to insertion in the eye, plus
2) wearing piggy-backed on silicone hydrogel soft lenses packed in borate-buffered liquid, plus
3) frequent application of artificial tears buffered with boric acid,
combine together to deliver a toxic cocktail of borate/boric acid, and in higher doses than has been studied.

Since the two studies seem to strongly suggest boric acid/borate buffered solutions in just oneof these three solutions has a cytotoxic effect on corneal epithelial cells, I'm trying to seek alternatives to reduce the total exposure to borate/boric acid solutions with the hope of healthier corneas and slowing the degenerative scar formation (Salzmann's).

With the approval of my eye doctor, I've discontinued use of the silicone hydrogel lenses and report great improvement in the dry eye pain. The silicone hydrogels acted as sponges, and created more of a drying effect instead of helping to provide moisture. Now back to wearing only the GP lenses which still fail to correct my vision.

The use of the Refresh Plus in place of Refresh Tears seems to be another incremental improvement.

Now I'm looking for a non-preserved saline without the borate/boric acid buffering agents. (Both Unisol and Simply Saline are borate buffered solutions). The only phosphate buffered solution listed in the study is a product manufactured by AMO, called Complete Moisture Plus which was recalled in 2007 and 2009 due to a link with "Acanthamoeba Keratitis, a rare, painful eye infection that can lead to permanent vision loss or blindness".

At my eye doctor's recommendation, I've always relied on Unisol because it's preservative-free, and I have no experience with other saline solutions. Will search for preservative free saline solutions with phosphate buffering.

Will continue my journey and post progress.

Blinks

[spmcc]

Now I'm looking for a non-preserved saline without the borate/boric acid buffering agents.

You could check out Sodium Chloride Solution 0.9% (pink vials found behind the pharmacy, but no Rx needed). Here's a link to a box from amazon.com: http://www.amazon.com/Sodium-Chlorid..._sim_sbs_hi_12

I'm not 100% sure, but I don't think it contains borate/boric acid.

Good luck.

[Blinks]

Thanks, SPMCC, for the lead! Will check it out!

Blinks

[Cari]

Hi Blinks...

I recently discovered by accidental trial and error, followed by some research that every product I've used that contains boric acid or sodium borate is very irritating to my eyes. I don't know if it was the original cause of my dry eye problem, but I had switched contact solutions when this started a year ago and now realize that it had boric acid listed first and my previous one had sodium borate listed fifth. Even if it is not the original cause, it certainly hasn't helped to pour it into my eyes in almost every product I've tried, including acuvue dailies and refresh optive "sensitive"! I have figured out a few products I like, which it turns out are the ones without it. So... a couple more suggestions are Aquify contact solution, Bion preservative free tears, Refresh celluvisc preservative free and genteal gel for severe dry eyes. These three give different levels of viscosity for different needs. When I can tolerate my contacts, I've done okay with Blink for contacts. It has sodium borate at least lower on the list. My eye doctor, who I trust, also told me that you can use regular artificial tears for rewetting. I haven't tried it, bit I think Bion would work the best because it is the least viscous.
The articles you cited were interesting. I would like to fine out what my contacts are buffered with, but they're not on the list. Hope I helped a little...your post was helpful to confirm what I had been thinking!

[Blinks]

Hi Cari,

Thanks for sharing your experience and for the suggestions on alternative products. Very helpful!

It may be possible to identify the buffer contained in your contact lens package by looking for the label insert for your lens. Sometimes the label can be found online. I have three different contact lenses for trial as piggy backs and none contained the label insert. However, I did find inserts online on the manufacture's sites. I believe the FDA requires the insert be available upon request from your doctor.

Yesterday I found Aquify with sodium hyaluronate to try when (if) I have some new contacts that work. It's hard to find Aquify in stores. It seems to be a wetting agent, rather than a lubricating agent as artificial tears, but I learned of this from two articles:
Chemical properties of Contact Lens Rewetters, by Loretta B. Szczotka-Flynn, OD, MS, FAAO, 4/1/2006
Hyaluronan: A Review of its Properties, Ophthalmic Uses and Research, Marjorie Rah, OD, PhD, 4/1/2010
Both of the above articles are available on the clspectrum.com website.

I continue to be amazed with outstanding results with the Refresh Plus preservative-free during the day, and Refresh Celluvisc at night. There is just no more burning sensation at all. I really think the combination of a lot of borate-buffered products (a cocktail in the eye) over 16 hours can't be good for diseased corneas like mine.

My dry eye has never been diagnosed, but my doctor said it's very common in Grave's thyroid patients and in Salzmann's nodular corneal degeneration. There are some studies on Grave's ophthalmology reporting changes in the ocular surface. Part of the dry eye for me is due to mechanical action of the lid rubbing the nodules, so the tearflow isn't evenly coating the eye surface. My doctor recommended only preserved Refresh Tears or HypoTears (yikes, with BAK!!!). I know doctors sometimes give patients "bad grades" for non-compliance, but sometimes the patient knows best.

It's my belief the borate agent irritates my already very irritated corneas, sort of like the effect of putting salt in a wound. Perhaps someone with "normal" corneas might tolerate the borate buffered solutions very well.

So while my eyes feel less irritated, I've failed with several trials of contacts (RGPs, piggy backs, and hybrids) and my vision is still uncorrected. The cornea specialist offers surgery to remove the nodules, but there's a chance of a worse visual impairment due to prior surgery. I've contacted Boston Foundation for Sight for PROSE evaluation since they list Salzmann's as a disease they have experience with.

Blinks

[Cari]

Thanks for all of the info!

Best of luck finding someone who can help you. It was so freeing for me to find a doctor that I could ask questions and trust his answers, rather than feeling the burden of finding all of the research myself and trying to convince them that I knew anything about my condition!

Best wishes,
Cari

[ritaann333]

I am using retaine mgd eye drops which contains boric acid and don't like the feeling after use