50 EyeWorld Asia-Pacific | March 2025 CORNEA Many patients use drops to help with a variety of ophthalmic issues, however, one thing to consider is the formulation of these products, specifically if they have preservatives. Three ophthalmologists discussed the precautions with preservatives and shared the importance of monitoring for toxicity and potentially finding alternative treatment options. Anat Galor, MD, MSPH, said finding a preservativefree product is not as easy as you would think. “We’re always jealous because in Europe, they have a ton of preservative-free products,” she said. When talking about chronic medications like for glaucoma, the non-preserved medications are much more expensive. by Ellen Stodola, Editorial Co-Director Preservatives In Ophthalmic Medications And Alternative Strategies The best option would be to never use preservatives, but it’s not always feasible, so Dr. Galor tries to identify the patients who have toxicity from preservatives, mostly based on epithelial staining patterns, and tries to switch those that show adverse effects. Dr. Galor offered several key principles in these scenarios: 1) Don’t put patients on medications they don’t need; carefully consider if they need chronic medications; 2) talk to patients about different types of medications, what they’re buying over the counter, etc., and make sure they’re making good decisions; 3) monitor for toxicity in anyone who uses chronic eye drops with preservatives; in the office, stain with vital dyes, and if you see it, that’s a patient population where you can consider other options. It doesn’t have to be non-preserved drops; it could be options like SLT. Meibomian gland dropout in patient with long-standing glaucoma medication use. Source: Anat Galor, MD, MSPH
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