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Doctors awareness on the consequences of preservatives

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Altough few ophtamologist are well versed in this particular aspect of medical toxicology, it seems that progress has been made in the treatment and care of dysfunctional tear syndromes as far as preserved eye drops are concerned. Obviously, it depends on the ophthamlmology service and how many dry eye and ocular surface patients they treat. In these situations, the deleterious effects of preservatives are evident soon enough to establish a causative effect very quickly. Some teams, like the one of the Quinze-Vingts in Paris, are even specialised in preservative consequences related publications. But many other medical services who treat less fragile ocular surfaces still continue to prescribe one or several preserved drops in higher concentrations that the maximum recommend by pharmaceutical companies (usually less than 4 drops a day). Actually one might argue that "drops" don't mean anything since a drop containing a percentage of 0.005 is not the same as one containing 0.01 of the same preservative. And what about a different preservative? what about the combination of two different preservatives?. The other important question is: for how long? Let's remind them that dry eyes and glaucoma are lifetime diseases. However, it's also obvious to our members and delegations abroad that some progress has been made, even if for most of our membres finding preservative-free treatments is still a dilema. Let's not forget that doctors are also confronted to this lack of choice and probably why so many preserved drops are still being prescribed currently. But little by little, they are beginning to have a choice for dry eyes, glaucoma and allergies, even though the choice is still insufficient and the preservative-free prescritpion reflex is not always there.

Let's see examine a few examples of eye care practionners involved in the "fight against preservatives" worldwide:

Probably more than toxicity, it's the severe allergic reactions and intolerance that practionners take into account. Thus some specialised teams prescribe more and more single use vials and other unpreseved bottles to dry eye and allergy sufferers. But in a meeting on ocular allergies, it was stated that " benzalkonium represents 4 to 11% of "sensitisations" and mercurial derivatives 13 to 37 %, but more than that, they have a toxic effect" [1].

In August 2005, a team of ocular surface experts convened in Chicago to discuss the latest information on  treating dry eye syndrome and real-world issues in artificial tear therapy, including preservative use. The group stated that ocular surface health should always remain a top priority and that Preferred Practice Pattern Dry Eye Syndrome Medical Treatment guidelines should be modified to recommend the use of preservative-free formula artificial tear products for all levels of dry eye conditions in consideration of the medical benefit they offer to dry eye syndrome sufferers. The Dry eye consensus group recommended increased use of preservative-free artificial tear formulations as first-line therapy [2].

The Hong Kong Association of Private Eye Surgeons (HKAPES) warned that frequent use of eye-drops could damage eyes and might even cause loss of vision.  HKAPES said most eye-drops contained preservatives that were harmful to eyes. A study made by the University of Hong Kong stated that most users were ignorant of the risk. Nearly 70 percent of the 518 polled (aged between 20 and 50) knew preservatives in eye-drops were harmful but had no idea that they were contained in most eye-drops. HKAPES President John Chang said preservatives, especially detergent, could lead to blurred vision and lengthen the period of recovery after an eye surgery. Contact-lens users could also be at risk because the lenses act as a reservoir for the chemicals. This problem is all the more important since only a few of the respondents (17 percent) used eye-drops after consulting an ophthalmologist. Most preferred buying it in pharmacies [3].

Thus, even if medical awareness increases regarding preservatives, a new questions arises related to pharmacies and users' awareness when these purchase drops without a prescription.

1 Association pour la promotion de l’allergologie en Aquitaine (APALA), by  Bruno Mortemousque  Bordeaux Hospital, notes taken by Dr H. Masson, Novembre 2003.

2.  Increasing importance of dry eye syndrome and the ideal artificial tear: consensus views from a roundtable discussion, Asbell, Penny A , Current Medical Research and Opinion, Volume 22, Number 11, November 2006 , pp. 2149-2157(9).

3. Eye drops might cause blindness,, 2005-08-04 09:37:47