scholarly journals Ocular benzalkonium chloride exposure: problems and solutions

Eye ◽  
2021 ◽  
Author(s):  
Michael H. Goldstein ◽  
Fabiana Q. Silva ◽  
Nysha Blender ◽  
Trung Tran ◽  
Srilatha Vantipalli
Keyword(s):  
Ocular Surface ◽  
Benzalkonium Chloride ◽  
Signs And Symptoms ◽  
Clinical Effects ◽  
Corneal Epithelial ◽  
Multiple Strategies ◽  
Symptom Scores ◽  
Problems And Solutions ◽  
Surface Staining ◽  
Preservative Free

AbstractPreservatives in multidose formulations of topical ophthalmic medications are crucial for maintaining sterility but can be toxic to the ocular surface. Benzalkonium chloride (BAK)—used in approximately 70% of ophthalmic formulations—is well known to cause cytotoxic damage to conjunctival and corneal epithelial cells, resulting in signs and symptoms of ocular surface disease (OSD) including ocular surface staining, increased tear break-up time, and higher OSD symptom scores. These adverse effects are more problematic with chronic exposure, as in lifetime therapy for glaucoma, but can also manifest after exposure as brief as seven days. Multiple strategies are available to minimize or eliminate BAK exposure, among them alternative preservatives, preservative-free formulations including sustained release drug delivery platforms, and non-pharmacological therapies for common eye diseases and conditions. In this paper, we review the cytotoxic and clinical effects of BAK on the ocular surface and discuss existing and emerging options for ocular disease management that can minimize or eliminate BAK exposure.

Comparison of Ocular Surface Cytological Appearance in Glaucoma Patient Treated with Timolol Maleat 0,5% Latanoprost 0,005% and Timolol-Latanoprost Fixed Combination Preservative Free Eye Drop

2019 ◽  
Vol 44 (2) ◽  
pp. 82
Author(s):  
Maretha Amrayni ◽  
Elsa Gustianty ◽  
Susi Heryati ◽  
Andika Prahasta ◽  
Maula Rifada ◽  
...  
Keyword(s):  
Epithelial Cells ◽  
Cell Density ◽  
Goblet Cell ◽  
Ocular Surface ◽  
Fixed Combination ◽  
Cell Contact ◽  
Corneal Epithelial ◽  
Preservative Free ◽  
Goblet Cell Density ◽  
Epithelial Metaplasia

Introduction : The longterm use of topical antiglaucoma might cause ocular surface instability due to active substance or preservative used. Impression cytology examination may reveal superficial epithelial cells on conjunctiva and cornea, including goblet cells. Goblet cell density decrease is the most important parameter on evaluation of ocular surface disorder. Objective : This study was to understand ocular surface remodeling due to active substance of topical antiglaucoma with impression cytology examination among the patient prior and 3 months after therapy. Methods : This was a randomized controlled trial study with single blind masking. A total of 45 eyes from 31 patients were used as subject and distributed onto three groups treatment, which were timolol maleat 0.5%, latanoprost 0.005%, and latanoprost-timolol maleat fixed combination. All topical antiglaucoma in this study were preservative free. Result : There were differences between 3 groups in goblet cells density after 3 months therapy (p=0,030). Goblet cell density in timolol group was lower than latanoprost (p=0,041) and fixed combination (p=0,045). There was no significantly difference between 3 groups in conjunctival epithelial metaplasia degree (p=0,706) and cell to cell contact degree in corneal epithelial cells (p=0.66) after 3 months therapy. Conjunctival epithelial metaplasia degree were increased among group of timolol (p=0,008) and fixed combination (p=0,046). Conclusion : Timolol maleat 0,5% caused lower goblet cell density after 3 months therapy compare with latanoprost and fixed combination. There was no significantly difference in conjunctival epithelial metaplasia and cell to cell contact degree in corneal epithelial cells among these glaucoma treatment groups.

scholarly journals Changes in Ocular Surface Characteristics after Switching from Benzalkonium Chloride-Preserved Latanoprost to Preservative-Free Tafluprost or Benzalkonium Chloride-Preserved Tafluprost

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Naoto Tokuda ◽  
Yasushi Kitaoka ◽  
Akiko Matsuzawa ◽  
Ayaka Tsukamoto ◽  
Kana Sase ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Barrier Function ◽  
Benzalkonium Chloride ◽  
Tear Film ◽  
Ophthalmic Solution ◽  
Surface Characteristics ◽  
Epithelial Barrier ◽  
Epithelial Barrier Function ◽  
Corneal Epithelial ◽  
Preservative Free

Purpose. The aim of the present study was to examine the effects of switching from Latanoprost ophthalmic solution containing a preservative to preservative-free Tafluprost ophthalmic solution or Tafluprost containing a preservative on ocular surfaces. Materials and Methods. Forty patients (40 eyes) with glaucoma (mean age: 62.0 ± 10.9 years) using Latanoprost with preservative for six months or longer were assigned either to a Tafluprost-containing-preservative group (20 eyes) or preservative-free-Tafluprost group (20 eyes). The intraocular pressure, corneal epithelial barrier function (fluorescein uptake concentration with fluorophotometer FL-500), superficial punctate keratopathy (AD classification), and tear film breakup time (TBUT) were assessed before switching and at 12 weeks after switching. Results. No significant differences in intraocular pressure were noted after switching in either group. Corneal epithelial barrier function was improved significantly after switching in both the Tafluprost-containing-preservative and the preservative-free-Tafluprost groups. There were no significant differences in AD scores after switching in the Tafluprost-containing-preservative group, but significant improvements were noted in the preservative-free-Tafluprost group. No significant differences in TBUT were noted in the Tafluprost-containing-preservative or preservative-free-Tafluprost groups after switching. Conclusion. After switching from preservative Latanoprost to Tafluprost containing-preservative or preservative-free Tafluprost, corneal epithelial barrier function was improved while the intraocular pressure reduction was retained.

scholarly journals How Ocular Surface Disease Impacts the Glaucoma Treatment Outcome

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Snježana Kaštelan ◽  
Martina Tomić ◽  
Kata Metež Soldo ◽  
Jasminka Salopek-Rabatić
Keyword(s):  
Ocular Surface ◽  
Microbial Contamination ◽  
Standard Form ◽  
Ocular Surface Disease ◽  
Treatment Goals ◽  
Corneal Epithelial ◽  
Glaucoma Treatment ◽  
Preservative Free

The treatment goals for glaucoma are lowering the intraocular pressure and preservation of vision. Topical hypotensive drops are the standard form of therapy which is often associated with some symptoms of toxicity, ocular inflammation, allergy, or ocular surface disease (OSD). OSD is a common comorbidity in glaucoma patients, and its prevalence with glaucoma increases with age. Use of topical treatment could additionally increase symptoms of OSD mostly due to preservatives added to multidose medication bottles used to reduce the risk of microbial contamination. This toxicity has been particularly associated with BAK, the most commonly used preservative which damages conjunctival and corneal epithelial cells and significantly aggravates OSD symptoms. OSD adversely affects patients’ quality of life causing discomfort and problems with vision which in turn may result in noncompliance, lack of adherence, and eventually visual impairment. In the management of glaucoma patients OSD symptoms should not be overlooked. If they are present, topical glaucoma treatment should be adapted by decreasing the amount of drops instilled daily, using BAK-free or preservative-free medication and lubricants if necessary. Awareness of the presence and importance of OSD will in turn improve patients' adherence and compliance and thus ultimately the preservation of long-term vision.

scholarly journals ACE2 and TMPRSS2 are expressed on the human ocular surface, suggesting susceptibility to SARS-CoV-2 infection

2020 ◽  
Author(s):  
Lingli Zhou ◽  
Zhenhua Xu ◽  
Gianni M. Castiglione ◽  
Uri S. Soiberman ◽  
Charles G. Eberhart ◽  
...  
Keyword(s):  
Viral Entry ◽  
Ocular Surface ◽  
Immunohistochemical Analysis ◽  
Signs And Symptoms ◽  
Epithelial Surface ◽  
Corneal Epithelial ◽  
Contact Precautions ◽  
A Cell ◽  
Superficial Epithelium ◽  
Portal Of Entry

AbstractPurposeConjunctival signs and symptoms are observed in a subset of patients with COVID-19, and SARS-CoV-2 has been detected in tears, raising concerns regarding the eye both as a portal of entry and carrier of the virus. The purpose of this study was to determine whether ocular surface cells possess the key factors required for cellular susceptibility to SARS-CoV-2 entry/infection.MethodsWe analyzed human post-mortem eyes as well as surgical specimens for the expression of ACE2 (the receptor for SARS-CoV-2) and TMPRSS2, a cell surface-associated protease that facilitates viral entry following binding of the viral spike protein to ACE2.ResultsAcross all eye specimens, immunohistochemical analysis revealed expression of ACE2 in the conjunctiva, limbus, and cornea, with especially prominent staining in the superficial conjunctival and corneal epithelial surface. Surgical conjunctival specimens also showed expression of ACE2 in the conjunctival epithelium, especially prominent in the superficial epithelium, as well as the substantia propria. All eye and conjunctival specimens also expressed TMPRSS2. Finally, western blot analysis of protein lysates from human corneal epithelium obtained during refractive surgery confirmed expression of ACE2 and TMPRSS2.ConclusionsTogether, these results indicate that ocular surface cells including conjunctiva are susceptible to infection by SARS-CoV-2, and could therefore serve as a portal of entry as well as a reservoir for person-to-person transmission of this virus. This highlights the importance of safety practices including face masks and ocular contact precautions in preventing the spread of COVID-19 disease.

The Effects of Polyquad-Preserved Travoprost, Benzalkonium Chloride-Preserved Latanoprost, Purite-Preserved Brimonidine and Preservative-Free Tafluprost on Ocular Surface: A Rabbit Ocular Surface Study

2017 ◽  
Vol 26 (3) ◽  
pp. 149-161
Author(s):  
Burcu GÖRGÜLÜ ŞAHİN ◽  
Özcan OCAKOĞLU ◽  
İsmail SEÇKİN ◽  
Sibel DEMİRCİ DELİPINAR ◽  
Tuğba EKİZ YILMAZ ◽  
...  
Keyword(s):  
Ocular Surface ◽  
Benzalkonium Chloride ◽  
Surface Study ◽  
Preservative Free

Comparison of the Toxicity Profile of Benzalkonium Chloride-Preserved Tafluprost and SofZia-Preserved Travoprost Applied to the Ocular Surface

2015 ◽  
Vol 31 (3) ◽  
pp. 156-164 ◽  
Author(s):  
Takashi Kanamoto ◽  
Yoshiaki Kiuchi ◽  
Masaki Tanito ◽  
Shiro Mizoue ◽  
Tomoko Naito ◽  
...  
Keyword(s):  
Ocular Surface ◽  
Benzalkonium Chloride ◽  
Toxicity Profile

scholarly journals A combination of CMC and α-MSH inhibited ROS activated NLRP3 inflammasome in hyperosmolarity stressed HCECs and scopolamine-induced dry eye rats

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ying Lv ◽  
Chenchen Chu ◽  
Ke Liu ◽  
Yusha Ru ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Dry Eye ◽  
Nlrp3 Inflammasome ◽  
Ocular Surface ◽  
Combined Treatment ◽  
Underlying Mechanism ◽  
Oxygen Species ◽  
Corneal Epithelial ◽  
Melanocyte Stimulating Hormone ◽  
Human Corneal Epithelial Cells ◽  
Conjunctival Goblet Cells

AbstractAn important mechanism involved in dry eye (DE) is the association between tear hyperosmolarity and inflammation severity. Inflammation in DE might be mediated by the NLRP3 inflammasome, which activated by exposure to reactive oxygen species (ROS). A combination of carboxymethylcellulose (CMC) and α-melanocyte stimulating hormone (α-MSH) may influence DE through this mechanism, thus avoiding defects of signal drug. In this study, we assessed whether treatment comprising CMC combined with α-MSH could ameliorate ocular surface function; we found that it promoted tear secretion, reduced the density of fluorescein sodium staining, enhanced the number of conjunctival goblet cells, and reduced the number of corneal apoptotic cells. Investigation of the underlying mechanism suggested that the synergistic effect of combined treatment alleviated DE inflammation through reduction of ROS level and inhibition of the NLRP3 inflammasome in human corneal epithelial cells. These findings indicate that combined CMC + α-MSH treatment could ameliorate lesions and restore ocular surface function in patients with DE through reduction of ROS level and inhibition of NLRP3 signalling.

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