ReviewEye (London, England)2022
Ocular benzalkonium chloride exposure: problems and solutions.
Review in Eye (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 132 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
132 citing papers in PubMed, 1 synthesis or guideline pooled it, 206 citations in OpenAlex.
- Efficacy of Perfluorohexyloctane for the Treatment of Patients with Dry Eye Disease: A Meta-Analysis.Ophthalmic research · 2025Pooled it
- Comparison of Preservative-Free and Preserved Latanoprost in Primary Open-Angle Glaucoma: A Randomized Cross-Over Study.Korean journal of ophthalmology : KJO · 2026Trial
- Bioequivalence of Preservative-Free and Preserved Omidenepag Isopropyl 0.002% Ophthalmic Solutions in Patients With Primary Open Angle Glaucoma or Ocular Hypertension: Phase 3 DAISY Study.Journal of glaucoma · 2025Trial
- Trial
- A Randomized, Multicenter Phase 3 Clinical Trial Evaluating Intracanalicular Dexamethasone Insert for the Treatment of Allergic Conjunctivitis.Clinical ophthalmology (Auckland, N.Z.) · 2024Trial
- The Effects of Low Viscosity Preservative-Free Chloroprocaine Ophthalmic Gel 3% versus BAK-Containing Tetracaine 0.5% on the Bactericidal Action of Povidone-Iodine.Clinical ophthalmology (Auckland, N.Z.) · 2024Trial
- Changing from preserved, to preservative-free cyclosporine 0.1% enhanced triple glaucoma therapy: impact on ocular surface disease-a randomized controlled trial.Eye (London, England) · 2023Trial
- Efficacy and Toxicity Evaluation of Bepotastine Besilate 1.5% Preservative-Free Eye Drops Vs Olopatadine Hydrochloride 0.2% Bak-Preserved Eye Drops in Patients with Allergic Conjunctivitis.Clinical ophthalmology (Auckland, N.Z.) · 2023Trial
- Understanding the effects of ciprofloxacin on corneal epithelial cells: a study using electric cell-substrate impedance sensing (ECIS) technology.Experimental eye research · 2026Article
- Global landscape and thematic evolution of glaucoma pharmacotherapy research (1996-2025): A bibliometric and science mapping analysis.International ophthalmology · 2026Article
- Chronic Ocular Surface Pain: A Missing Member of the Chronic Overlapping Pain Conditions?Drugs · 2026Review
- An Update and Overview of the Ocular and Extraocular Microbiome and Its Impact on Ophthalmic Care.Advances in therapy · 2026Review
- Effectiveness of a heparin-like glycosaminoglycan from snail mucus in a murine model of dry eye.Journal of translational medicine · 2026Article
- Punctal and Intracanalicular Drug Delivery Systems for Ophthalmic Use: A Narrative Review of Technologies, Clinical Outcomes, and Critical Quality Attributes.Pharmaceutics · 2026Review
- Treatment Persistence with Combination Eye Drops for Glaucoma: A Longitudinal Analysis Using Japanese Medical Claims Data.Ophthalmology and therapy · 2026Article
- Stability and Compressibility of Tear Film Lipid Layer: Impact of Benzalkonium Chloride Presence.bioRxiv : the preprint server for biology · 2026Article
- Thermal load management in photorefractive keratectomy: a comprehensive review of cooling strategies.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026Review
- The Effects of Intraocular Pressure-Lowering Drops on the Tear Film Assessed by a Novel High-Resolution Tear Film Imager.Diagnostics (Basel, Switzerland) · 2026Article
- Evaluation of contamination in preservative-free multi-dose Brimonidine eye drops: a comparative study.Japanese journal of ophthalmology · 2026Article
- Controlling Staphylococcus aureus skin infections by targeting biofilm and virulence properties using FDA-approved antiseptics and skin care products.Folia microbiologica · 2026Article
72 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Preservatives in multidose formulations of topical ophthalmic medications are crucial for maintaining sterility but can be toxic to the ocular surface. Benzalkonium chloride (BAK)-used in approximately 70% of ophthalmic formulations-is well known to cause cytotoxic damage to conjunctival and corneal epithelial cells, resulting in signs and symptoms of ocular surface disease (OSD) including ocular surface staining, increased tear break-up time, and higher OSD symptom scores. These adverse effects are more problematic with chronic exposure, as in lifetime therapy for glaucoma, but can also manifest after exposure as brief as seven days. Multiple strategies are available to minimize or eliminate BAK exposure, among them alternative preservatives, preservative-free formulations including sustained release drug delivery platforms, and non-pharmacological therapies for common eye diseases and conditions. In this paper, we review the cytotoxic and clinical effects of BAK on the ocular surface and discuss existing and emerging options for ocular disease management that can minimize or eliminate BAK exposure.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.