What is sodium hyaluronate eye drops

How to find the right eye drops and what are the differences

0

Finding eye drops to treat dry eyes can be a real challenge. There is an immense selection of suppliers and products that use a wide variety of active ingredients.

At first glance, the composition of the drops seems rather complicated. However, a little background knowledge helps to find the right eye drops. Learn what individual ingredients mean and what to look out for.

Optional: preservatives

The use of preservatives in eye drops is very controversial. The funds are added to the drops due to their germicidal effect. On the one hand, this makes sense, because everything that comes into direct contact with the eyes should be as sterile as possible in order to avoid germs.

On the other hand, preservatives can irritate the cornea and conjunctiva of the eye and thus permanently damage it. An already irritated eye is particularly sensitive to this. In addition, some preservatives reduce the stability of the tear film and can make dry eyes even worse.[1]

A preservative-free alternative should therefore be chosen, especially for longer-term use.

Eye drops with preservatives are also not suitable for contact lens wearers. The liquid remains between the lens and the cornea for a long time, as a result of which the preservatives are in contact with and irritate the cornea for a long time.[2]

Cetrimide, Benzalkonium Chloride, Polyhexanid (PHMB), Polidronium (Polyquad), Sodium Chlorite (Purite) and Sodium Edetate are such preservatives. You can also recognize eye drops without preservatives by the addition of O.K., Sine or SE.

To prevent contamination with germs, eye drops without preservatives are filled in special containers. These are constructed in such a way that the agent can get out, but vice versa nothing can get into it. See the package leaflet for information on how long you can use the eye drops after you have opened them.

Alternatively, there are eye drops in so-called single dose ophthiols (EDO), which can be used for 24 hours after opening the pack.

Buffer substances for a physiological pH value

Eye drops contain buffer solutions that are used to regulate the pH value. Most of them are buffers containing phosphate or citrate. Eye drops containing phosphate can lead to calcification in an already damaged cornea and cause visual impairment.[3] People with corneal problems should therefore choose a preparation without a phosphate buffer.

Auxiliary film builder

Film formers stabilize the tear film. They differ primarily in their viscosity. The more viscous the eye drops, the longer they stay on the surface of the eye. In the case of very dry eyes, eye drops that are slightly more viscous should therefore be used. The disadvantage of a high viscosity is that the view can be temporarily disturbed.

The following film formers are used for eye drops:

Slime-stabilizing polymers

The tear film consists of three layers. Due to its composition, the innermost layer of mucus protects the cornea and facilitates the movement of the eyelids over the eyeball. It also protects against bacteria and other intruders. The mucus layer also improves the even distribution of the tear film and stabilizes it at the same time.

The polymers include:

Povidone and PVA

With polyvinylpyrrolidone (PVP or povidone) and polyvinyl alcohol (PVA), thin liquid solutions can be produced.[4],[5]The two active ingredients are well suited for mild complaints.[6]

"LAC OPHTAL MP sine", "OCULOTECT fluid sine" and "Protagent SE eye drops" contain povidone and, according to Stiftung Warentest, are well suited for the treatment of dry eyes.[7]

Cellulose derivatives and carbomers

Cellulose derivatives and carbomers are more viscous than povidone and PVA and therefore work a little longer.[8],[9] Eye drops with these active ingredients are good for moderate complaints.[10]

"BERBERIL Dry Eye EDO" and "SIC OPHTAL Sine" contain the cellulose derivative hypromellose. Both drops are recommended for dry eyes.[11]

Hyaluronic acid

Hyaluronic acid is usually found in eye drops in the form of sodium hyaluronate. Hyaluronic acid is an endogenous substance that occurs naturally in the eye. Therefore, the tolerance is particularly good. This active ingredient can bind a lot of water, which makes it possible to achieve a high viscosity. In addition, hyaluronic acid promotes wound healing in the cornea.[12],[13] It is therefore well suited for severe complaints.[14]

"ARTELAC Splash", "HYA OPHTAL" and "HYABAK Eye Drops" are examples of eye drops containing hyaluronic acid that work on dry eyes.[15]

Guaraprolose

Guaraprolose is a chemical derivative of guar gum. The specialty of this substance is that it is liquid as a solution, but immediately becomes viscous when it comes into contact with the surface of the eye, so that the drops stick in the eye for a long time.[16]

"Systane UD wetting drops" contain guaraprolose and are well suited for dry eyes.[17]

Fat layer stabilizing substances

The fat layer forms the outer layer of the tear film and thus prevents the tear fluid from evaporating. Dry eyes are often due to an instability of this fatty layer. If this is the case, eye drops containing lipids can help.[18]

In addition to lipids, these eye drops usually also contain a polymer that stabilizes the mucous layer. Artelac Lipids eye drops, for example, contain a carbomer and medium-chain fatty acids, the so-called MCTs (from English for medium-chain triglycerides).[19]

Dexpanthenol

Dexpanthenol is a derivative of pantothenic acid, which is one of the B vitamins. Dexpanthenol has a regenerating effect on the cornea and conjunctiva of the eye and also has hydrating properties. However, the effectiveness of dexpanthenol in dry eyes has not yet been clearly demonstrated. Since it can occasionally lead to intolerance such as burning or itching of the eyes, Stiftung Warentest advises alternative preparations that can do without this active ingredient.[20]

Glycerin, propylene glycol and polyethylene glycol

These substances are added to some eye drops as they ensure that the film-forming agents stay in the eye longer.[21],[22]

Eyebright (Euphrasia)

Eyebright is a plant extract that is said to have antibacterial and anti-inflammatory properties. A therapeutic efficacy for dry eyes has not been proven, however.[23]

Other therapeutic agents

All eye drops mentioned so far are available without a prescription in pharmacies or drugstores. Depending on the cause of the development of dry eyes, additional therapeutic agents can be added. However, these are usually only available with a prescription, which is why dry eyes must be diagnosed by a doctor.

Vitamin A is essential for the function and health of the eyes. A deficiency in this vitamin must be compensated for with a dietary supplement.[24] Eye drops containing vitamin A can therefore support the therapy.[25],[26] However, vitamin A deficiency is rarely found in Germany and is therefore not one of the common causes of dry eyes.

Cyclosporine A has an anti-inflammatory effect.[27] Since dry eyes often cause inflammatory reactions, which in turn promote dryness, anti-inflammatory agents are a sensible therapeutic approach.[28] Cyclosporin A also stimulates tear production, a positive side effect for dry eyes.[29]

Also Corticoidcontaining eye drops have an anti-inflammatory effect.[30]

If the dry eyes are due to an infection, the use of eye drops is recommended Antibiotics.[31]

Eye drops are as varied as the number of complaints

There are many different eye drops on the market with a wide variety of active ingredients and combinations of active ingredients. The tolerance and effectiveness of individual preparations is very individual. It is advisable to try eye drops with different active ingredients. For example, some eye drops contain more than one film former, which can be beneficial for some people. However, eye drops with a single active ingredient should first be tried before combinations of active ingredients are used.

In general, preservatives should be avoided as far as possible. If you have problems with the Meibomian gland, which produces the fatty layer of tears, eye drops containing lipids are recommended.

Test reports can also be helpful in finding the right eye drops. In the article about tests and comparisons for eye drops, you can find out which eye drops performed best in the Stiftung Warentest and in the Öko-Test.


swell

[1] Walsh K, Jones L. The use of preservatives in dry eye drops. Clin Ophthalmol. 2019; 13: 1409-1425. [2] Markoulli M, Kolanu S. Contact lens wear and dry eyes: challenges and solutions. Clin Optom (Auckl). 2017; 9: 41-48. [3] Kompa S, Redbrake C, Dunkel B, Weber A, Schrage N. Corneal calcification after chemical eye burns caused by eye drops containing phosphate buffer. Burns. 2006; 32 (6): 744-7. [4] Guillon M, Maissa C, Pouliquen P, Delval L. Effect of povidone 2% preservative-free eyedrops on contact lens wearers with computer visual syndrome: pilot study. Eye Contact Lens. 2004; 30 (1): 34-9. [5] Calles JA et al. Polymers in Ophthalmology. 2015. 10.1007 / 978-3-319-12478-0_6 [6] Wolf E. The eye sees red. Pharmaceutical Newspaper. https://www.pharmazeutische-zeitung.de/ausgabe-182008/das-auge-sieh-rot/. 04/24/2008. Retrieved on September 14, 2019. [7] 9 medications assessed for: dry eyes. Stiftung Warentest. https://www.test.de/medikamente/krankheit/trockene-augen-k4/tabelle/#/h8e54b9d1-f8b9-4d3f-844f-58611d5bacb4. 09/01/2019. Retrieved on September 14, 2019. [8] Solomonidou D, Cremer K, Krumme M, Kreuter J. Effect of carbomer concentration and degree of neutralization on the mucoadhesive properties of polymer films. J Biomater Sci Polym Ed. 2001; 12 (11): 1191-205. [9] Mukhopadhyay R, Gain S, Verma S, Singh B, Vyas M, Mehta M, Haque A. Polymers in designing the mucoadhesive films: A comprehensive review. International Journal of Green Pharmacy. 2018; 12. S330-S344. [10] Wolf E. The eye sees red. Pharmaceutical Newspaper. https://www.pharmazeutische-zeitung.de/ausgabe-182008/das-auge-sieh-rot/. 04/24/2008. Retrieved on September 14, 2019. [11] 7 medications assessed for: dry eyes. Stiftung Warentest. https://www.test.de/medikamente/krankheit/trockene-augen-k4/tabelle/#/hffc92a8c-aaff-4ee0-92a7-a7ca0ed1ff08. 09/01/2019. Retrieved on September 14, 2019. [12] Guillaumie F, Furrer P, Felt-Baeyens O, Fuhlendorff BL, Nymand S, Westh P, Gurny R, Schwach-Abdellaoui K. Comparative studies of various hyaluronic acids produced by microbial fermentation for potential topical ophthalmic applications. J Biomed Mater Res A. 2010; 92 (4): 1421-30. [13] DeLuise VP, Peterson WS. The use of topical Healon tears in the management of refractory dry-eye syndrome. Ann Ophthalmol. 1984; 16 (9): 823-4. [14] Wolf E. The eye sees red. Pharmaceutical Newspaper. https://www.pharmazeutische-zeitung.de/ausgabe-182008/das-auge-sieh-rot/. 04/24/2008. Retrieved on September 14, 2019. [15] 17 evaluated drugs for: dry eyes. Stiftung Warentest. https://www.test.de/medikamente/krankheit/trockene-augen-k4/tabelle/#/h52139da8-39c1-49b0-a0f2-4aa54cae8566. 09/01/2019. Retrieved on September 14, 2019. [16] Ubels JL, Clousing DP, Van Haitsma TA, Hong BS, Stauffer P, Asgharian B, Meadows D. Pre-clinical investigation of the efficacy of an artificial tear solution containing hydroxypropyl-guar as a gelling agent. Curr Eye Res. 2004; 28 (6): 437-44. [17] SYSTANE UD wetting drops for the eyes. Stiftung Warentest. https://www.test.de/medikamente/medikament/systane-ud-benetztstropfen-fuer-die-augen-n626/. 09/01/2019. Retrieved on September 14, 2019. [18] Lee SY, Tong L. Lipid-containing lubricants for dry eye: a systematic review. Optom Vis Sci. 2012; 89 (11): 1654-61. [19] ARTELAC LIPIDS. BAUSCH + LOMB. https://www.bausch-lomb.de/produkte/augenbefuchten/artelacr-lipids/. Retrieved on September 14, 2019. [20] Dexpanthenol. Stiftung Warentest. https://www.test.de/medikamente/ffektstoff/augenmittel-dexpanthenol-w33/?focus=indi_k4. 09/01/2019. Retrieved on September 14, 2019. [21] De Campos AM, Sánchez A, Gref R, Calvo P, Alonso MJ. The effect of a PEG versus a chitosan coating on the interaction of drug colloidal carriers with the ocular mucosa. Eur J Pharm Sci. 2003; 20 (1): 73-81. [22] Hydroxypropyl guar + polyethylene glycol 400 + propylene glycol or polyvinyl alcohol + povidone (eye drops / combination). Stiftung Warentest. https://www.test.de/medikamente/ffektstoff/filmbildner-hydroxypropyl-guar-polyethylene glycol-400-propylene glycol-oder-polyvinylalkohol-povidon-augentropfen-kombination-w43/ 09/01/2019. Retrieved on September 14, 2019. [23] Assessment report on Euphrasia officinalis L. and Euphrasia rostkoviana Hayne, herba. EMA / HMPC / 246799/2009. [24] Alanazi SA, El-Hiti GA, Al-Baloud AA, et al. Effects of short-term oral vitamin A supplementation on the ocular tear film in patients with dry eye. Clin Ophthalmol. 2019; 13: 599-604. [25] Kubo Y, Arimura A, Watanabe Y, Nakayasu K, Kanai A. Effect of vitamin A palmitate on vitamin A-deficient rabbits. Nippon Ganka Gakkai Zasshi. 1999; 103 (10): 729-33. [26] Toshida H, Funaki T, Ono K, et al. Efficacy and safety of retinol palmitate ophthalmic solution in the treatment of dry eye: a Japanese Phase II clinical trial. Drug Des Devel Ther. 2017; 11: 1871-1879. [27] Turner K, Pflugfelder SC, Ji Z, Feuer WJ, Stern M, Reis BL. Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporine ophthalmic emulsion. Cornea. 2000; 19 (4): 492-6. [28] Pflugfelder SC, de Paiva CS. The Pathophysiology of Dry Eye Disease: What We Know and Future Directions for Research. Ophthalmology. 2017; 124 (11S): S4 – S13. [29] Yoshida A, Fujihara T, Nakata K. Cyclosporin A increases tear fluid secretion via release of sensory neurotransmitters and muscarinic pathway in mice. Exp Eye Res. 1999; 68 (5): 541-6. [30] Turner K, Pflugfelder SC, Ji Z, Feuer WJ, Stern M, Reis BL. Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporine ophthalmic emulsion. Cornea. 2000; 19 (4): 492-6. [31] Wood M. Conjunctivitis: Diagnosis and Management. Community Eye Health. 1999;12(30):19–20.