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Is it time for a moratorium on the use of benzalkonium chloride in eye drops?
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  • Luca D'andrea,
  • Marina Montemagni,
  • Giuseppe Celenza ,
  • Roberto Iorio,
  • Ciro Costagliola
Luca D'andrea
University of Naples Federico II

Corresponding Author:dandrea.luca91@gmail.com

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Marina Montemagni
University of Naples Federico II
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Giuseppe Celenza
University of Aquila
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Roberto Iorio
University of Aquila
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Ciro Costagliola
University of Naples Federico II
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Abstract

Benzalkonium chloride (BAC) is a quaternary ammonium compound commonly employed as a preservative in several multidose eye drops. Its use is associated with several adverse events, particularly when used chronically. Topically instilled BAC acts not only on superficial structures but also reaches deeper tissues (trabecular meshwork, optic nerve) and can be deleterious in patient under chronic treatment. In glaucomatous patients, BAC is the primary cause of ocular surface disease (OSD), and it can lead to significant morbidity, influence treatment compliance, quality of life, and surgical outcomes. Clinical and experimental evidence demonstrates that BAC causes instability of the tear layer, loss of goblet cells, apoptosis, subclinical neuroinflammation, and antibiotic resistance. Considering the validity of the alternative formulations (alternative preservatives or preservative-free formulations) it is unreasonable to persist in using such toxic compounds and, perhaps it is time for a moratorium on the use of BAC in eye drops.
13 Jan 2022Submitted to British Journal of Clinical Pharmacology
18 Jan 2022Submission Checks Completed
18 Jan 2022Assigned to Editor
01 Feb 2022Reviewer(s) Assigned
26 Feb 2022Review(s) Completed, Editorial Evaluation Pending
01 Mar 2022Editorial Decision: Revise Major
31 Mar 20221st Revision Received
01 Apr 2022Submission Checks Completed
01 Apr 2022Assigned to Editor
01 Apr 2022Review(s) Completed, Editorial Evaluation Pending
09 Apr 2022Editorial Decision: Accept