Additional Substances to Glaucoma Medication: Preservative Free Treatment

  • Giedre Pakuliene


Benzalkonium chloride (BAK) is one of the most popular preservatives, used in antiglaucomatous drugs. BAK mechanism of action is based on its’ ability to interfere with microorganisms’ cell membranes, causing lipid dispersion and lysis [1]. BAK is highly lipophilic and acts as a detergent on the tear film. [2] Corneal cell membranes are also composed of phospholipid bilayer, which is susceptible to BAK [3].


  1. 1.
    Noecker R. Effects of common ocular preservatives on ocular health. Adv Ther. 2001;18(5):205–15.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Robciuc A, Witos J, Ruokonen SK, Rantamäki AH, Pisella PJ, Wiedmer SK, Holopainen JM. Pure glaucoma drugs are toxic to immortalized human corneal epithelial cells, but they do not destabilize lipid membranes. Cornea. 2017;36(10):1249–55.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Chang S-W, Chi R-F, Wu C-C, Su M-J. Benzalkonium chloride and gentamicin cause a leak in corneal epithelial cell membrane. Exp Eye Res. 2000;71(1):3–10. Scholar
  4. 4.
    Pauly A, Brignole-Baudouin F, Labbé A, Liang H, Warnet J-M, Baudouin C. New tools for the evaluation of toxic ocular surface changes in the rat. Invest OpthalmolVis Sci. 2007;48(12):5473. Scholar
  5. 5.
    Niwano Y, Iwasawa A, Ayaki M. Ocular surface cytotoxicity and safety evaluation of Tafluprost, a recently developed anti-Glaucoma prostaglandin analog. Ophthalmol Eye Dis. 2014;6:5–12. Scholar
  6. 6.
    Cvenkel B, Ihan A. Ocular surface changes induced by topical Antiglaucoma monotherapy. Ophthalmologica. 2002;216(3):175–9. Scholar
  7. 7.
    Iester M, Telani S, Frezzotti P, Motolese I, Figus M, Fogagnolo P, Perdicchi A. Ocular surface changes in glaucomatous patients treated with and without preservatives Beta-blockers. J Ocul Pharmacol Ther. 2014;30(6):476–81. Scholar
  8. 8.
    Liang H, Brignole-Baudouin F, Pauly A, Riancho L, Baudouin C. Polyquad-preserved Travoprost/timolol, Benzalkonium chloride (BAK)-preserved Travoprost/timolol, and Latanoprost/timolol in fixed combinations: a rabbit ocular surface study. Adv Ther. 2011;28(4):311–25. Scholar
  9. 9.
    Izzotti A, La Maestra S, Micale RT, Longobardi MG, Saccà SC. Genomic and post-genomic effects of anti-Glaucoma drugs preservatives in trabecular meshwork. Mutat Res. 2015;772(February):1–9. Scholar
  10. 10.
    Boimer C, Birt CM. Preservative exposure and surgical outcomes in glaucoma patients: the PESO study. J Glaucoma. 2013;22(9):730–5. Scholar
  11. 11.
    Tailor R, Batra R, Mohamed S. A National Survey of Glaucoma specialists on the preoperative (trabeculectomy) management of the ocular surface. Semin Ophthalmol. 2014;31(6):1–7. Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Giedre Pakuliene
    • 1
  1. 1.Lithuanian University of Health ScienceKaunasLithuania

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