View Full Version : Benzalkoinium Chloride Damage
I was exposed to Benzalkonium Chloride preservative in eye drops for 6 years. I am showing signs of corneal corosion. It also made my eyes feel drier. I have been off them for 6 weeks and my eyes do feel less dry but I am still craving the drops. My left eye is really really red, but that's probably because I was addicted to the vasoconstrictor more so than the preservative. I am currently on a preservative free steroid to help get me through this. I can't even begin to imagine what this eye might look like when I have to come off the steroids. I am willing to ride this out for as long as possible and see how I go. I have read several case studies about the effect of benzalkonium and its effect on the pre corneal tear film. However nothing really states if this is long term or short term. One report it even said it destroys the mucus layer. Does anyobody know if this means permanently or just while you are exposed to it? Can you get over toxicity from this preservative the longer you are off it??
Benny-we have a regular guy on the bb who has damage from this exact thing. Look for posts by Neil. There are many telling of his problems. He is on the bb currently sporadically now as he is traveling. I'm sure he will see your post and say "hey" to you.
Neil has other problems, but this is one he is very familiar with.
Thanks Lucy. I was going to write to Neil but heard that he was travelling. From what I have read his toxicity was from nasal spray (?) I may be wrong. It probably causes same damage whther spray or drops.
Do a search on "Neil0502" and you'll pull up pearls of wisdom, knowledge and a little tinge of b.s. (Sorry, Neil)
I do not know Neil's case well, as I'm too deeply involved in my own stuff. I do seem to be Neil's personal secretary lately - a task I gladly and (with a snicker) do without his approval.
Neil's FIRST AND FOREMOST problems, if my memory serves me right is that BAK torched his corneas. I think his sinus' may be involved to a lesser degree, but I can assure you that just by reading a search of his posts, you'll learn it all. Happy searching.
Darn, I posted a reply and lost it. While I don't know Neil's case well as I am too absorbed in my own stuff, his problem FIRST AND FOREMOST was BAK torched corneas.
If you'll do a search on "Neil0502" you'll find all of his stuff, and there is a lot of it, along with a tinge of wisdom and b.s. (Hee Hee) I seem to be Neil's personal secretary lately, a position I take without his approval, but get a snicker doing. Here's a start. Now, I'm done and you can read his postings and learn from the BAK leader on destruction.
I was exposed to Benzalkonium Chloride preservative in eye drops for 6 years...However nothing really states if this is long term or short term. One report it even said it destroys the mucus layer. Does anyobody know if this means permanently or just while you are exposed to it? Can you get over toxicity from this preservative the longer you are off it??
Neil recently met with an expert in France who knows a lot about this I think. Hopefully when he's back online he can share more with you.
I will answer you more thouroughly and properly later on (too busy this week) but I am particularly insterested to know about your case and the preservative free steroid? what's the brand name, composition? sure it's PF?
because PF solutions are essential for people like you and me...
I have had regularly erosions while using BAK containing solution... so I stopped but this means dealing with the initial problem.
Have a look at the my posts search Kakinda and mabye try Scout as well..
some interesting threads should appear.
Neil and I have discussed working on a STOP BAK webpage,
so definitely more later,
I am particularly insterested to know about your case and the preservative free steroid? what's the brand name, composition? sure it's PF?
because PF solutions are essential for people like you and me...
Here in the UK my DR put me on a 10 day course of preservative free Prednisolone Sodium Phosphate (0.5%) brand name Minims (Chauvin Pharmaceuticals Ltd Surry KT2 6TN).
Comes packaged in a box of 20 single dose unit, not sure if this is useful information for you or not.
My doc put me on the exact same brand as Ian's (Minims). I have been on it for about a month. I don't know about other countries but it is very expensive in Australia. For the first two weeks I used everyday. Now I maybe use them every third day. They are a really great anti inflammatory. My corneas have improved so much since using them. I am also taking glucosamine and I think the combo of the two is really helping with the damage that was caused.
preservative free Prednisolone Sodium Phosphate (0.5%) brand name Minims (Chauvin Pharmaceuticals Ltd Surry KT2 6TN).
This appears to be the standard PF steroid used here in the UK, it had been the one I was always on when I was using steroid drops.
Ok, thanks, did you have a look the threads i mentioned?
Could send me a copy of the leaflet by mail or email? If so I'll send you a private mail... I've been looking for a PF option for years and so have my docs here in France, including Dr Baudouin (the one Neil saw recently). He said that this PF option is very much needed generally (not just for me) but labs haven't been so willing to produce a PF version here. Keratos, our DE association in France and Portugal, is trying to lobby in favour of PF solutions so I would really appreaciate if you could send us a copy of the leaflet to show Dr. B.
I am considering going to the UK to get some... I guess i need a prescription, would a French prescription do? can someone ask a pharmacy in the UK please. I take prednosilone per os to avoid benzalkonium, I'm sure it would be more productive to use it topically.
I had no serious erosions this year except in June when I had to use BAK containing [O] Patanol or another steroid called Flucon over here for about a week. Same thing last year, the more serious erosion was caused in August when i had to use Opatanol a few days in a row...
The problem is that my allergies are so severe that i cannot work without taking Patanol and steroids... this is why I started to take them orally but then one doc try to convince me to try again in June this year (i was really reticent but doc knows best). well in this case he didn't so I'm sticking to the only solution i have currently... oral prednisolone
did you see my posts regarding BAK in Patanol or Opatanol... BAK in allergic conjunctivitis -therefore usually chronic use- is a non-sense... even more so in DE patients.
If there is no media -maybe threads like this one- lab will continue to ignore this important health safety issue.
Take care... hence do not use BAK
Neil here. Lucy is a highly over-qualified ... but NOT unappreciated ... secretary ;-)
Seven years of BAK ... contained in cycloplegic drops ... prescribed to treat accommodative spasm (charley horse in the eyes) fried my eyes ... as confirmed by Christophe Baudouin, in Paris. I see him again on Tuesday.
Aside from severe dry eye, it seems to have caused =me= 'corneal hyperesthesia--' unusual and extreme sensitivity of the cornea. Life pretty well sucks.
Worse, now the dry eye causes blurred vision, only aggravating the underlying condition--problems with the focusing mechanism.
Baudouin Rxd three months of Doxy (nothing) and three months of "Indocollyre--" a European PF NSAID drop ... again... nothing.
More later....all the best....Neil
Could someone please send me a copy of the leaflet by mail or email?
I've been unable to find the PF version on the internet.
Please do a "benzalkonium" search on this forum as well
Could someone please send me a copy of the leaflet by mail or email?
I've been unable to find the PF version on the internet.
Please do a "benzalkonium" search on this forum as well
Kakinda, Sorry I missed this response. Did you get the information you wanted or are you still looking.
You can email me directly if you want to and I will see what I can do. Unfortunately, I don't have any packaging on the product as I threw it all out after my 10 day course.
No, I don't have all the info I wanted (I got some limited info on the net though including a fax number, but I wish I had an email as well but hey... ).
But I'd really appreaciate to receive the inner leaflet to show doctor Baudouin (the world's renowned anti-BAK specialist if you will) that such an option exists in the UK. I wanted him to a look at the whole composition of minims pred. This indicates a change in the all-BAK trend... good news. So if anyone uses it, could that person keep one leaflet for us and if possible send it. I don't need the packaging just the leaflet.
Could someone ask a UK pharmacy:
1. cost . maybe you know that Ian?
2. prescription needed (would a French prescription work?)
I'll ask Chauvin over here why don't not manufacturing minims PF over here.
Doc B clearly agreed with me that it is very much needed in France and Portugal... and others of course, it's not just what Keratos' members think... "ouf!". We're doing some progress...
we shall overcome this BAK overwhelming use nonsense... I just discussed that with Neil the other day.
It's seems the minims brand is a group of rather old drugs but in PF version.
I think i saw an antibiotic as well... it's great but surely they can improve things -reducing side-effects- by using milder steroid, etc...
but for people who can't stand of BAK it's an option where we had none. It's almost my case...
Take care... hence stay away from BAK.
It seems that this company produces a lot of PF drugs here in the UK.
I will try and get you an inner leaflet.
As far as prescription cost goes, in the UK it is £6.65 for an NHS prescription per item. Usually an item is a months supply, for example my GP prescribes me Minims Saline PF in single use vials (they come in a box of 20) but because I use them 2-3 a day, I get 3 boxes on my prescription for £6.65.
I will ask my pharmacy tomorrow but I would imagine that NHS prescriptions would be limited to UK residents for obvious reasons. They may however, dispense it as a private prescription (on your french prescription) where you then pay the actual drug cost.
Maybe you could make direct contact with the company or have your doctor contact them to check about availability.
yes, the minims brand is a group of rather old drugs but in PF versions... at least they safe BAK-wise although they may produce more side-effects that new and milder steroids in the case of prednisolone... If by any chance you came across a complete list of the minims series could you please send it to me....
If you can please ask what the actual cost is?
It is historically a French lab (Montpellier) so I'm going to contact them about getting minims here... just need to find some time to do that.
....my GP prescribes me Minims Saline PF in single use vials (they come in a box of 20) but because I use them 2-3 a day, I get 3 boxes on my prescription for £6.65.
Yeah I get the exact same thing. But I managed to get 4 boxes under one prescription. If I pestered my GP even more, I may be able to get more!
I asked at my pharmacy on Friday and they said that they could only dispense on a NHS Dr's prescription from a UK Dr.
I asked about a private prescription and they said it wasn't possible.
I am very new to this NHS prescription stuff myself, maybe someone else can offer some assistance.
I don't have the insert either, if someone else has a copy maybe they could forward it through to you.
Sorry I can't be more assistance.
Ive also used the Minims prednisolone - the first prescription I had was a private one and I paid around £20+ for one boox/20 vials - so not exactly cheap. Further prescriptions were NHS ones.
They also do Dexamethasone but these are even stronger than the pred. Its a shame they dont do FML as a pres free, its not as mild as the lotemax etc but at least its milder than the prednisolone.
Minims also produce:
Chloramphenicol (a doc at the hospital where I worked gave me some for an eye infection - this ones kept on all wards in the fridge - broad spectrum).
Artificial tears and saline.
Range of glaucoma meds in single use vials - sorry can't find an inclusive list.
Range of drops used to aid in the examination of eyes including, flourosceine (sp?) rose bengal, and other drops used in eye exams, cycoplegic drops etc. The NHS must have a contract with them because you go to any ophthalmologist here and you'll see the trademark blue and white boxes scattered around the office.
Back to the steroids - Im sure I still have the inserts if you want me to send it just let me know.
yes, Keratos (and myself) would appreaciate having a copy of the insert. It's one alternative for people who can't stand preservatives when there is none currently in France, in spite of many requests by the main French hospitals... and Keratos
I'll send you a private email on Kerato's address...
I hope they will produce a PF version of a milder steroid someday... that would really make sense medically...remember primo non nocere (first do no harm)... or first do less harm should i say (no preservative and less side-effects).
Thanks a lot,
....my DR put me on a 10 day course of preservative free Prednisolone Sodium Phosphate (0.5%) brand name Minims (Chauvin Pharmaceuticals Ltd Surry KT2 6TN).
It seems I was mistaken the steroid I was on is:
Minims 0.1% Dexamethasone Sodium Phosphate PhEur (DSP 0.1) and not Minims 0.5% Prednisolone Sodium Phosphate BP (Pred 0.5)
I have no idea what the difference between the two is, nor am I sure how I could make such a mistake in the first place.
Anyway, Minims make two PF steroid drops (as well as the Saline - which I use also).
Sorry if this has caused any confusion.
Dexamethasone is another type of steroid of course.... so if it's not too much of a bother could you please keep an insert next time for me and send it to Keratos.
dexa... lasts longer so that's why every other day or every third day is usually the posology, I don't think that's the case for prednisolone.
But I would like to learn more about long term side effects and compare it to prednisolone.
I will try to ask that to Baudouin next time. I'm sure this is an important issue for you as well.
But i don't think this is the mild steroid...we are hoping for in PF version.
in the US, Lotemax is supposed to have much improved safety profile - as it's a ketone instead of ester, or vice versa. In any case, the bad part is that, as like most other steroids and prescriptions, it contains benzalkonium chloride.
Plfugfelder, et al. wrote an article pertaining to the use of Lotemax for dry eye patients with delayed tear clearance - and it is shown to help, but in patients with "delayed tear clearance" - the BAK stays on the surface of the eye longer, thus somewhat negating the positive improvements of the steroid. I have "delayed tear clearance" because of my conjunctivochalasis - so it isn't very helpful to me. I don't know what other conditions would have "delayed tear clearance". I did not have LASIK or any refractive eye surgery.
I checked with my pharmacist to determine if a preservative-free version could be compounded - and the response was that the raw materials are not available on the market, so no, a preservative-free version can not be compounded. Which is really a shame, because a safer steroid would benefit so many dry eye patients, myself included.
So I would guess that the patent for Lotemax would have to run out first in order for a non-preservative version to be available?
If anyone is interested - Leiter's Pharmacy has a number of other ophthalmic compounded solutions - and trehalose is one of them. Trehalose has been shown in studies to prevent dehydration - and Leiter's Rx for Trehalose is preservative-free – If interested in the studies, just do a search on pubmed or medline for trehalose and dry eyes. Don't know how many opthalmologists would be willing to write Rxs for Trehalose, but it may be worth a shot.
I've tried to get my eye doc to hook me up with autologous serum drops, but his response was that it contained IgG, and wouldn't benefit me. I don't know if it would help my condition or not, but do know that the autologous serum is one (of a few possibilities) of an eye drop that would be preservative-free.
Don't know if that helps anyone,
Re Lotemax: no PF version yet... so not really an option for most of us. Unless the pharmas are forced to produce a PF version. ;)
Re trelahose: I don't know what happened to trehalose in commercial terms... i saw fantastic reports a few years ago and then... If you try them please keep us posted.
Re Autologous serum. If you are allergic, then you may have IgE in them as well. It certainly a good option to get growth factors you can't get anywhere else as of late 2006. Certainly an option to heal ulcers, RCE, etc...I just wish they could remove the bad things in it too (such as the inflammatory substances we both mentioned). Once they'll be able to do that, then there will be a lot of future applications for these drops...
Hi. Johnny One-Note here ... your friendly anti-BAK lunatic.
Here's another pretty intelligible indictment of BAK after clinical studies comparing unpreserved lube drops, lube drops preserved with BAK, and lube drops preserved with chlorobutanol.
Benzalkonium chloride is
known to have significant toxic effects on the corneal
epithelium even when compared with other preserva-
tives. Such effects could be demonstrated for the corneal
epithelium of the rabbit in numerous scanning electron
microscopic studies. Even in concentrations
of 0.001% to 0.1% benzalkonium chloride leads to loss
of microvilli, disruption of intercellular connections and
finally even to complete desquamation of the superficial
Benzalkonium chloride affects the diffusion barrier
of the corneal epithelium in two ways: (1) benzalkonium
chloride leads to disruption of the zonulae occludentes,
which seal off the superficial epithelial cells, thereby al-
lowing aqueous substances into the intercellular space
of the epithelium; (2) the benzalkonium chloride mole-
cules are incorporated into the cellular membranes of
the epithelial cells by their lipophilic chains, thus provid-
ing gates for ionic, aqueous substances to penetrate
through the lipophilic membranes into the intraceUular
space. An increase in corneal epithe-
lial permeability due to topically applied benzalkonium
chloride has been demonstrated both in vitro and in
vivo in rabbits, as well as in human subjects.
The benzalkonium chloride molecules are bound onto
the corneal surface immediately after instillation, wher-
eby the preservative escapes rapid washout by the tear
film. Even 9 days after instillation of a single drop
containing 0.01% benzalkonium chloride residues of the
preservative have been detected in the rabbit epithelium
by a radiocarbon technique. The half-time life of
benzalkonium chloride in the corneal epithelium of the
rabbit is about 20 h, so application several times
daily leads to an accumulation of the preservative. Al-
though preservatives seem to damage the corneal epithelium
of rabbits more than human beings, it is conceiv-
able that when benzalkonium chloride is used as a pre-
servative in artificial tears and is applied several times
per day over long periods, it is accumulated in the corne-
al epithelium, thus leading to further destabilization of
the compromised dry corneal surface. In addition, as
benzalkonium chloride is a detergent, it emulsifies the
lipid layer of the tear film, further compromising the
already insufficient tear film in dry eyes.
The noxious effect of benzalkonium chloride as a pre-
servative in artificial tears was demonstrated both objec-
tively and quantitatively in the present clinical study.
In contrast to the other two tear substitutes tested in
this study, artificial tears preserved with benzalkonium
chloride failed to improve the disturbed corneal epitheli-
al barrier function in dry eyes. Preservation of artificial
tears with benzalkonium chloride should therefore be
Original article: http://www.springerlink.com/content/l8701g32882226h5/fulltext.pdf
NOTE: I'm going to reach out to the author to see if he'd work with me/some of us to get this preservative out of our eyes....
Vicki In Oregon
The local dry eye expert prescribed me Xibrom. I immediately took it because I was trusting the doctor and was desperate. He also diagnosed me with recorring corneal erosion dystrophy which the other doctors had not. Waited months to get an appt. It is an anti inflammatory. My eyes have only worsened since they began in June and the rest of my dry areas as a result of Sjorgens that was just confirmed. So maybe that is why restasis has not worked. Anyway, today I was looking at the Xibrom I have been using twice a day and the 2nd ingredient is benzalkonium chloride. (.05mg/ml). My eyes kill me 24/7 and my vision is messed up. I am sleepy 24/7 no matter how much I sleep. Not sure what part of that is due to my eyes hurting and feeling so tired they just want to be permanently closed versus fatigure from the sjorgens and fighting the pain all the time. Now I wonder what new kind of damage may have been caused with the BAK and the little bit of hydrogen peroxide that got in my eye. Plus, a week ago I accidentally got hydrogen peroxide in my left eye and since then that eye has not been the same despite my flushing it out and using artificial tears so much. I worry I may have caused permanent problems only because I am not starting off with healthy eyes nor healthy immune system to fight it. I am unclear as to waht this serum is and how you get it? And has it helped anyone?
Any advice appreciated. Thank you.
I am unclear as to waht this serum is and how you get it? And has it helped anyone?
If you are talking about autologous serum drops you can read about them in this forum (http://www.dryeyezone.com/talk/forumdisplay.php?f=55) and in this listing (http://www.dryeyezone.com/encyclopedia/autologousserum.html).
If you have concerns about BAK in a prescription eyedrop that you have been prescribed, you should talk to your doctor about it to better understand the tradeoffs and whether there may be an acceptable alternative.
Yet another study (feel free to ignore if you're already a "True Believer" ;) )
I do NOT know how long BAK stays in the eye, the punctal plugged eye, the cauterized eye, the contact lens-wearing eye, etc., etc., BUT ... other studies show that the BAK molecule is NOT washed away by tears, so ... it's reasonable to assume that it hangs in there for a long time.
So ... BAK quickly induces evaporative dry eye, too. In't that special? Hmm?
Impact of short-term exposure of commercial eyedrops preserved with benzalkonium chloride on precorneal mucin.Chung SH, Lee SK, Cristol SM, Lee ES, Lee DW, Seo KY, Kim EK.
Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. firstname.lastname@example.org
PURPOSE: The aim of this study is to investigate the short-term effects of benzalkonium chloride (BAC), a preservative used in many ophthalmic topical solutions, on precorneal mucin in humans. METHODS: Immortalized human corneal-limbal epithelial (HCLE) cells were exposed to eyedrops containing BAC solutions at 0.0025% and 0.01% concentrations for a period of 15 min. Human corneal epithelium was acquired with consent, as a byproduct of elective excimer photorefractive keratectomy procedures after application of Ocuflox eyedrops (0.3% ofloxacin with 0.0025% BAC) for 1 week before surgery. The relative expression of the MUC1 and MUC16 mucin gene was determined by conventional and real-time reverse transcription-polymerase chain reaction (RT-PCR). Monoclonal antibodies for MUC1 (HMFG-1) and MUC16 (OC125) were used in western blot analysis to detect MUC1 and MUC16. Human corneas exposed to 0.01% BAC solutions were examined by transmission electron microscopy. RESULTS: The expression of MUC1 and MUC16 gene transcripts was not changed after exposure to BAC in HCLE cells and human corneal epithelium. However, MUC1 and MUC16 were reduced after exposure to BAC in HCLE cells and human corneal epithelium. Transmission electron microscopy of the anterior corneal surface revealed fixation of the mucous layer after exposure to 0.01% BAC for 5 or 15 min; prolonged exposure (60 min) to 0.01% BAC destroys the mucous layer. CONCLUSIONS: This study demonstrates that short-term exposure to BAC can alter the precorneal mucin.
Vicki In Oregon
Neil this is terrible. I had no idea this ingredient was in there. I didnt think to look because this guy is suppose to be "the dry eye guy" here. I dont get why he would prescribe me this. This is terrible. I have used this a lot and from reading on this forum, people have developed dry eyes, including me, even in as little as 2 weeks from a medication. Now I use this stuff for many weeks with the dry eyes I already have. Why would he prescribe me this!??!? I can no longer wear contacts but wonder if contact lens solutions include this ingredient? Did the use of this preservative cause you decrease in tears or quality tears or both? Since your cauterized eyes are not enough I assume the quality of your tears also. This is incredibly upsetting to me now. Tomorrow I will be getting upper control flow plugs and I fear it will either not be enogh pain relief or else experience blurriness like before.
BAK is an extremely common preservative used in nose sprays AND eyedrops. It is low in cost and effective in preserving these products against microbes that can cause spoilage or induce infection.
Unfortunately, it's also harmful to eyes and sinuses.
If your doctor prescribed you a drop preserved with BAK, then I would assume it's because your doctor is trying to help you get better. It's HUGELY clear to me that even the eye doctors that I've seen over the years--allegedly, some of the best in their fields--are NOT aware of this voluminous BAK research.
Including the guy who had me on BAK containing drops for over six years.
1) If your doc prescribed a BAK-containing drop, it may be prudent to discuss the matter with him or her calmly, professionally, and in a manner that is NOT confrontational or accusatory. Assume the doctor didn't know. They can't, and don't, know everything;
2) Ask your doctor if a preservative free version of ... whatever it is ... is available. If a PF version is NOT available, then ... well ... you AND your doctor have to make a risk-benefit decision together as to whether or not to proceed with the drop;
3) I gave this advice to somebody who faced a similar decision (do I or do I NOT use a BAK-preserved eyedrop):
When it comes to cost-benefit things like this, the decision has to be made by you in consultation with your doctor. Everybody's tolerance for risk is different.
Another important thing: if you have punctal plugs or cautery, the damage gets worse because the BAK hangs around on the eye for a much longer time (with TEARS, that's a good thing. With BAK, clearly not).
My advice (FWIW)? If you CAN find a PF-alternative, WHY NOT use it?
If you CAN'T find a PF alternative, then "insist" on getting baseline Schirmer's and TBUT measurements AND having them retested frequently--maybe even every week or two (sigh).
If the numbers start to drop, it's quite likely the BAK. At that point, it'll be up to you and your MD to decide risk/reward of continuing the treatment.
As to contact lens solutions, many people have had reactions to preservatives in THOSE drops, too, including thimerosal AND BAK (among others). Again, though, these preservatives were chosen for their RELATIVE safety, low cost, AND their ability to kill the bugs that can cause serious eye diseases. There are H2O2 and/or UV disinfection methods available, though they are not QUITE as effective against a few particular bugs as the traditional chemical preservatives.
BAK can cause corneal damage, corneal hyperesthesia, reduced Schirmer's (aqueous tear production), MGD (lipid layer), and reduced goblet cell density (mucin layer). Further, it can cause infectious and inflammatory conditions that do not respond to antibiotic or anti-inflammatory treatments.
Like everything else, though, try not to panic here. Just talk about your concerns with your doctor. If your doctor remains unconvinced, just suggest that he or she visit PubMed and search using the following keywords:
BENZALKONIUM CHLORIDE AND
It will become quickly apparent that this is a well-established connection.
Vicki In Oregon
THe doctor never gave me a choice. He never explaiend it could make things worse. There is no risk/benefit in this case, only risk. I complain of dry eyes so why does he prescribe me this I dont understand. Any advantage does not ever in my book make up for the risk. I think he should have given me the informaition I needed and yet he is the one who all the other doctors turn to for dry eye advice. I will try to relax about this but with my eyes as bad as they are it is hard. And yes, I do wear plugs and have taken this crap many weeks now twice a day. Thanks Neil.
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