Long-term eye drop treatment: laser and preservative-free drops to eliminate damage to the eye surface

The key to the success of any long-term (chronic) eye drop treatment is good patient cooperation. This includes the successful delivery of the drops (which is not as easy as you might think) and the drop application itself.

The latter decreases (deteriorates) if the drop causes discomfort (e.g. it stings, causes redness, the eye becomes irritated during the use of the drop, the eyelid skin shows an allergic reaction, the eye becomes watery or it becomes difficult to open the eye). Regarding the above, the treatment of glaucoma (glaucoma) is of particular importance.

In this disease, in most cases, regular use of eye pressure-lowering drops lasting years or decades is necessary to prevent vision deterioration or vision loss. That is why the methods by which the drops can be replaced (for example, if regular drops are no longer necessary after the selective laser trabeculoplasty treatment) or the most significant type of discomfort caused by the drops, damage to the eye surface caused by the preservative, can be eliminated (preservative-free drops). We discussed the above questions with Prof. Dr. Gábor Holló, an ophthalmologist and glaucoma specialist at the Ophthalmological Center.

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Why is long-term eye drop treatment necessary?

Long-term eye drop treatment is necessary in cases of allergies, dry eyes and especially glaucoma. In the latter group of diseases, the eye drops must ensure sufficiently large, pre-targeted low intraocular pressure so that glaucomatous damage to the optic nerve does not worsen. Ophthalmic preparations must be used in eye drops because the active substances taken orally cannot enter the eye from the blood. A molecular protective system protects the eye from foreign substances, if they arrive through the blood circulation. However, in the form of eye drops, the active ingredients are absorbed from the surface of the eye, through the cornea and conjunctiva. In this way, an effective and high concentration can be achieved inside the eye, while the effect on the body as a whole is minimal. In principle, the eye drops are therefore well absorbed by the eye, but for this it is necessary that the eye surface is intact and that the patient uses the drops correctly, based on the doctor’s instructions and regularly.

inflammation of the conjunctiva

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Factors complicating long-term eye drop treatment

During long-term treatment, not only the active ingredients of the eye drops, but also the preservatives, stabilizers and carriers are delivered to the eye. Therefore, it is not only important that the active ingredients have a sufficiently strong effect inside the eye, but also that the preservatives used in the drop solution, which serve to prevent bacterial, fungal and viral infections, do not damage the surface of the eye. Most of the preservatives – especially the most commonly used benzalkonium chloride – are pronounced cell toxins. This ensures its excellent anti-bacterial, anti-viral and anti-fungal effect. However, when used long-term, it also poisons the cells of the eye surface, and even promotes the evaporation of the tear film due to its detergent effect, which in itself leads to an increase in complaints caused by dry eyes. (Due to the long-lasting preservative effect, depending on the condition of the eye surface cells, a condition that develops over days or years is a ocular surface disease caused by anti-glaucoma eye drops, which we have dealt with extensively in our research published in several leading journals for several decades). During the long-term use of preserved eye drops over decades, the negative effect on the eye surface is essentially unavoidable for everyone. The cell damage caused by the preservative adds up in the long term, and this significantly worsens the success of, for example, an anti-glaucoma operation later on. That is why the procedures that can be used to eliminate or significantly reduce the toxicity caused by the chronic use of eye drops have come to the fore in the last decade and a half.

This is how to use eye drops correctly

How can the desired effect be achieved without preservatives?

The first and perhaps most important, but no longer considered a new treatment method, is the one in which the patient does not have to use eye drops at all. This in certain diseases – e.g. in open-angle glaucoma – it can be achieved by selective laser trabeculoplasty treatment of the corner of the eye. This outpatient procedure is still used in few places in our country. The treatment achieves the reduction of intraocular pressure through a physiological modifying effect on the aqueous humor drainage system, so it does not cause scarring. The treatment either completely replaces eye drop therapy or significantly reduces the need for eye drops in the case of open-angle glaucoma. To eliminate damage to the eye surface caused by chronic eye drops, eye drops that are completely preservative-free but contain active ingredients in a concentration similar to preserved preparations have become more and more available for about two decades. In the past, their production was not possible due to technological limitations. In the 1960s and 1970s, the main problem was caused by contamination of the solutions, which is why a high concentration of preservatives was desirable. Nowadays, however, with modern production technologies, eye drop packages that are completely preservative-free, but at the same time completely prevent infection of the solutions, have become widely available. Some of these are single-dose medication packages, in which, after opening, there is as much solution as is sufficient to treat both eyes once.

The other, more and more frequently used formula is the group of eye dropper-shaped medicine droppers that contain enough eye drops for many weeks, but are equipped with special filters. These are not just ophthalmic preparations, but e.g. the nasal spray solutions used in otolaryngology can also be delivered to the target organs without preservatives. It is true for both drops that no preservative toxicity occurs at all, and a wide range of patients tolerate such preparations much better in the long term than their traditional counterparts.

What should a person who suffers from the above complaints in connection with long-term use of eye drops do?

The use of preservative-free packaging began quite early in our country, which has gained more and more space in recent years. Nevertheless, there is a large number of glaucoma patients who chronically use eye drops whose active ingredients, preservatives or certain carriers are not well tolerated, and therefore struggle with milder or more serious eye surface complaints (eye redness, tearing, burning sensation, inability to keep the eyes open, redness of the eyelids, irritation). . Anyone who experiences such a complaint can rightly think that they are either intolerant to one of the active ingredients, or suffering from an allergic or preservative-induced ocular surface toxicity syndrome. It is important for everyone to know that the deterioration of the quality of life associated with chronic eye drop treatment is not necessary. After a proper, detailed ophthalmological examination, by abandoning the previous treatment and introducing a new treatment with a different active ingredient or preservative-free, if necessary, the effects that seriously impair the quality of life can be eliminated, while the optimal therapeutic effect can be preserved– says Prof. Dr. Gábor Holló, ophthalmologist and glaucoma specialist at the Ophthalmological Center.


Source: Napidoktor by napidoktor.hu.

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