The use of preservatives in dry eye drops

Karen Walsh, Lyndon Jones, Karen Walsh, Lyndon Jones

Abstract

Topical ocular preparations are widely recommended by health care professionals, or chosen by patients, to help manage dry eye disease (DED). The chronic and progressive nature of DED may result in the administration of topical products several times a day, over a period of many years. Given DED is a condition that by definition affects the ocular surface, it is important to understand how the repeated use of eye drops may impact the ocular surface, influence clinical signs, affect symptoms, and impact the overall disease process of dry eye. The component in topical preparations with the greatest potential to adversely affect the ocular surface is the preservative. This paper reviews the literature in relation to the use of preservatives in formulations for dry eye. The ocular effects of benzalkonium chloride (BAK) are summarised and compared to the performance of alternative preservatives and preservative-free formulations. Use of preserved and preservative-free drops in relation to the management of varying stages of DED is discussed.

Keywords: benzalkonium chloride (BAK); dry eye disease; polyquaternium-1 (PQ-1); preservative-free; preservatives.

Conflict of interest statement

Karen Walsh reports personal fees from Alcon, CooperVision and Johnson & Johnson Vision outside of the submitted work. Lyndon Jones reports personal fees from Alcon, CooperVision, Johnson & Johnson Vision, Menicon, Novartis, Ophtecs and Santen outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Decision tree for the use of preserved or preservative-free drops in the treatment of dry eye disease. Note: *Artificial tears may often be used as an adjunct therapy in combination with other management and treatment options as detailed by TFOS DEWS. When drops are considered, the flow diagram is intended to represent the conclusions from this review about the options for inclusion of preservatives in those formulations.

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Source: PubMed

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