It's time to name names.
As part of our preservative awareness campaign this year, I'm going to be highlighting from time to time products which I feel are amongst the most eggregious preservative offenders.
Topping my list of offenders will be anyone who is pushing BAK-preserved drops specifically for the treatment of dry eye symptoms.
Today's BAK Hall of Shame product
Bausch & Lomb sells a product called Advanced Eye Relief Dry Eye Lubricant Eye Drops. I ran across it at Safeway the other day, parked right in between two bottles of Theratears:
Follow my logic through to see the problem with this product:
#1. It is marketed specifically for dry eye.
This product is a lubricant eye drop, that is, it is packaged and sold specifically for dry eye, and says so prominently.
I only mention this to distinguish it from the many "combo" drops on the market that add a lubricant ingredient or two to something like a vasoconstrictor or antihistamine. Not that I intend to give those a pass by any means. I am simply emphasizing that this drop is targeting, solely and exclusively, the dry eye market.
#2. It is preserved with benzalkonium chloride (BAK).
If you are not familiar with benzalkonium chloride, also known as BAK or BAC, you can read more here. According to TFOS DEWS II Iatrogenic Dry Eye Report (the result of a 3-year international medical consensus project and published in 2017), BAK is harmful to the cornea and the tear system in up to seven different ways. BAK has been known for a long, long time to be harmful, and for the last 20 years, industry has been moving away from BAK, albeit far too slowly. They are switching to either preservative free or less toxic preservatives, and this issue is known to be most pressing in those drops that are expected or required to be used every day.
For reference, 0.01% is a typical concentration of BAK, neither lower nor higher than average for other drops, whether OTC or Rx.
#3. Yet B&L advertise it as "gentle" and say it can be used "as often as needed".
Here is how they describe it on their website (highlight mine):
Bausch + Lomb Advanced Eye Relief Dry Eye Lubricant Eye Drops soothes, refreshes and comforts irritated eyes. This formula contains two lubricants (glycerin and propylene glycol) that effectively moisturize dry eyes and help prevent further irritation. It replenishes tears for fast relief from dry eyes. And it is gentle enough to use as often as needed.*
Yes, of course I noticed the asterisk. Below, it says:
* See directions for use and warnings below
...which in turn refers to the Drug Facts, which say exactly what all other artificial tear labels say, INCLUDING the preservative-free ones, thanks to the FDA!
...Which brings me to my final point:
#4. All this, with the FDA's implicit blessing.
Few people seem to be aware of the gross inadequacies of FDA-mandated labeling for over-the-counter eye drops.
Did you know, for example, that ALL of what we call artificial tear products contain the following language, regardless of whether they are preservative-free, preserved with a mild or dissipating preservative, or preserved with BAK?
"Stop use and ask a doctor if... the condition worsens or persists for more than 72 hours."
Yes, every last one of them, from Refresh to Systane to TheraTears to who have you. And not because the company opts to say it. THE FDA REQUIRES IT!
For actual dry eye patients, obviously this makes no sense whatsoever. If chronic dry eye patients were to follow these instructions, they would either not be using artificial tears at all or they would be on the phone or in their doctor's office every third day.
But for general consumers who are just browsing eyedrops without a doctor's assistance, if preservative-free artificial tears have exactly the same warning as the very worst BAK-preserved Visine or ClearEyes redness reliever antihistamine combo drop, consumers have no way to distinguish what's safe. Worst and most likely, they will disregard all warnings as meaningless, obligatory drivel. Which, frankly, is exactly what they are. Read more here.
What's a consumer to do?
Bausch & Lomb: It's time to lead.
Are you up to the challenge?
Sadly, a few artificial tears preserved with BAK are still on the market. These puts unwary consumers at risk, particularly people who are purchasing drops without guidance from an eye doctor - commonly the case with anyone who has mild symptoms. By the time the disease has progressed enough for them to visit a doctor, they may already have sustained lasting damage.
But, by and large, these stragglers - the few remaining BAK-containing artificial tears - are generics, not name brands. This is why I chose the product that I did for today's blog post.
Bausch & Lomb, with an excellent market position and reputation, should be expected to lead rather than lag on important consumer health issues.
Consumers: Educate, and advocate.
Read more about benzalkonium chloride and the dry eye risks it carries.
Read more about the inadequacies of FDA-mandated label warnings on drops that may cause dry eye.
Read more about some common OTC and Rx drops containing BAK.
Search ingredient lists of lubricant eye drops on the US market.
And if you care about this issue, please consider contacting Bausch & Lomb and encouraging them to LEAD the way by moving to milder preservatives and preservative-free in all of their ophthalmic pharmaceutical products. (Hint: Bausch & Lomb are also the makers of Lumify.)
You are correct. There is reluctance to
move away from BAK in spite of the
evidence of harm for the chronic user.
Further evidence exits in the area of
topical antihistamines used for treating
ocular allergies, which can coexist with
dry eye conditions. There is none on
the market without BAK preservative.
This increases the challenge for helping
these patients most effectively.