Usage
This ophthalmic solution is prescribed primarily for the treatment of dry eye syndrome (DES) or keratoconjunctivitis sicca. It acts as a lubricant, offering temporary relief from burning, irritation, and discomfort associated with dry eyes. It can also be used for lubricating artificial eyes and hard contact lenses, and to protect the cornea during certain ophthalmic procedures. Its pharmacological classification is a lubricant and demulcent.
The mechanism of action involves Hydroxypropylmethylcellulose (HPMC) increasing tear film viscosity, improving its stability, and reducing evaporation. Borax and boric acid help maintain a pH similar to natural tears, and potassium chloride and sodium chloride ensure isotonicity of the solution.
Alternate Names
This combination is commonly known as Artificial Tears, Lubricant Eye Drops, or Hypromellose Eye Drops. Some brand names include Moisol, Freshkon, and Lubitina Plus. A more general term for similar formulations is Ophthalmic Demulcent Solution.
How It Works
Pharmacodynamics: HPMC lubricates the ocular surface, thus minimizing friction and discomfort. Borax and boric acid buffer the solution to maintain a pH compatible with the ocular surface. Potassium and sodium chloride maintain isotonicity, preventing osmotic stress to the ocular surface cells.
Pharmacokinetics: Topical administration results in minimal systemic absorption. The components are eliminated primarily through tear drainage.
Mode of Action: HPMC, a viscous polymer, increases the viscosity of the tear film, improving its stability and reducing tear evaporation.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: This ophthalmic solution does not exhibit receptor binding, enzyme inhibition, or neurotransmitter modulation. Its therapeutic action is primarily physical, enhancing lubrication and maintaining a healthy tear film.
Elimination Pathways: The components of the eye drops are primarily eliminated via tear drainage, with negligible systemic absorption.
Dosage
Standard Dosage
Adults: Instill 1-2 drops into the affected eye(s) as needed, typically up to 3-4 times per day, or as directed by a physician.
Children: The dosage for children is generally the same as for adults, although a physician should be consulted before administration, particularly for infants and young children.
Special Cases:
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Elderly Patients: No specific dosage adjustment is usually necessary.
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Patients with Renal Impairment: No specific dosage adjustment is needed, given negligible systemic absorption.
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Patients with Hepatic Dysfunction: No specific dosage adjustment is needed, given negligible systemic absorption.
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Patients with Comorbid Conditions: No specific adjustments are typically required unless the comorbid condition directly affects ocular health. In such cases, consult an ophthalmologist.
Clinical Use Cases
The standard dosage of 1-2 drops as needed (up to 3-4 times/day or as directed by the physician) applies across various clinical situations, including intubation, surgical procedures, mechanical ventilation, ICU use, and emergency scenarios.
Dosage Adjustments
Dosage adjustments are not generally needed. If symptoms do not improve with regular use, an ophthalmologist should be consulted.
Side Effects
Common Side Effects
- Temporary blurred vision
- Mild burning or stinging upon instillation
- Eye irritation (rare)
Rare but Serious Side Effects
- Allergic reactions (e.g., itching, redness, swelling) - discontinue use and consult a physician immediately.
Long-Term Effects
No long-term adverse effects have been reported with this combination of ingredients.
Adverse Drug Reactions (ADR)
Clinically significant ADRs are rare. If any unusual reactions occur, discontinue use and seek medical advice.
Contraindications
- Hypersensitivity to any of the ingredients.
Drug Interactions
HPMC can potentially prolong the contact time of other ophthalmic medications, possibly increasing their effects. Consult a physician if using other eye drops concurrently.
Pregnancy and Breastfeeding
Limited data is available on the use of this combination during pregnancy and breastfeeding. Due to minimal systemic absorption from topical ophthalmic administration, the risk is considered low. However, it is advisable to consult a physician if pregnant or breastfeeding.
Drug Profile Summary
- Mechanism of Action: HPMC lubricates; borax/boric acid buffers pH; sodium/potassium chloride maintains isotonicity.
- Side Effects: Blurred vision, burning/stinging, eye irritation (rare).
- Contraindications: Hypersensitivity to any of the ingredients.
- Drug Interactions: May prolong contact time of other eye drops.
- Pregnancy & Breastfeeding: Consult a physician before use.
- Dosage: 1-2 drops as needed, up to 3-4 times daily.
- Monitoring Parameters: Monitor for any signs of irritation or allergic reactions.
Popular Combinations
This particular combination is itself a commonly used formulation for dry eyes. Additional drug combinations are not typically required.
Precautions
- General Precautions: Wash hands thoroughly before use. Avoid touching the dropper tip to any surface to maintain sterility.
- Specific Populations: Consult with a physician for use during pregnancy and breastfeeding.
- Children & Elderly: The dosage for children and elderly patients is generally the same as adults, however, infants and young children should be evaluated by a physician before administration of eye drops.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Borax + Boric Acid + Hydroxypropylmethylcellulose + Potassium Chloride + Sodium Chloride?
A: The usual recommended dosage is 1-2 drops in the affected eye(s) as needed, up to 3-4 times per day. A physician can adjust the dosage and frequency as necessary.
A: Some brands may be compatible with contact lenses. However, it’s generally recommended to remove contact lenses before instilling the drops and wait 15-20 minutes before reinserting them. It’s essential to consult the product packaging and/or a physician or pharmacist for specific instructions regarding contact lens use. Some formulations may contain benzalkonium chloride, which can be absorbed by soft contact lenses and cause discoloration or irritation.
Q3: What are the common side effects?
A: The most common side effects are temporary blurred vision, mild burning or stinging upon application, and occasional eye irritation.
Q4: Are there any serious side effects?
A: Although rare, allergic reactions such as itching, redness, and swelling can occur. If these occur, discontinue use immediately and seek medical advice.
Q5: Can I use these drops long-term?
A: These drops are generally considered safe for long-term use to manage chronic dry eye. However, it’s essential to follow your doctor’s recommendations and schedule regular eye checkups.
Q6: What are the contraindications for this combination?
A: The primary contraindication is hypersensitivity to any of the ingredients. Patients with known allergies should carefully review the formulation components.
Q7: Can pregnant or breastfeeding women use these drops?
A: Due to limited systemic absorption, topical application is generally considered low risk. However, it’s crucial to consult a physician before use during pregnancy or breastfeeding.
Q8: How should this product be stored?
A: Store at room temperature, away from direct sunlight and excessive heat. Keep the bottle tightly closed when not in use. Discard the bottle after the expiry date or after 28 days from opening, even if there is solution remaining. Avoid touching the dropper tip to any surface to prevent contamination.
Q9: What should I do if my symptoms worsen or persist despite using the eye drops?
A: If your dry eye symptoms worsen or do not improve after regular use as directed, consult an ophthalmologist. It may be necessary to explore other treatment options or investigate any underlying causes.
Q10: Can I use these eye drops with other ophthalmic medications?
A: HPMC can interact with other ophthalmic medications, so consult your doctor or pharmacist before use if using other eye drops.
