Preservatives in Topical Ophthalmic Medications: Historical and Clinical Perspectives

P. David Freeman; Malik Y. Kahook


Expert Rev Ophthalmol. 2009;4(1):59-64. 

In This Article

Expert Commentary

While the various preservatives discussed in this review appear to protect multidose bottles from contamination by common pathogens effectively, they have variable effects on the ocular surface and may lead to long-term deleterious effects on ocular surface health. A balance between antimicrobial efficacy and maintenance of ocular safety is ideal when exploring potential new preservatives for ophthalmic preparations. Industry trends appear to be in lessening the concentration of detergent preservatives or more recently moving away from detergent preservatives altogether. While this trend may be notable, the existence of BAK in ophthalmic preparations will be the mainstay for years to come owing to its efficacy, familiarity within the FDA, as well as its current widespread use in over 70% of existing multidose bottles. When using ophthalmic medications, it is important to attempt to minimize the exposure to detergent preservatives when possible and to treat ocular surface disease early and aggressively if these changes manifest with chronic topical therapies. This treatment should consist of the discontinuation of any unnecessary medications, attempting to limit the number of medicines containing BAK, and possibly changing medications.