Bacterial contamination of multi-use antibiotic steroid eye ointments and drops

Yilmaz, Omer Faruk; Sarmış, Abdurrahman; Mutlu, Muhammed Ali; Ersoy, Esma Ecem; Askarova, Ulviyya; Oğuz, Halit

doi:10.1007/s00417-023-05977-7

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…Regardless of the grade of Bell's phenomenon, corneal symptoms are mild in patients whose eyelids fully close while sleeping. Patients with open eyelids should be conservatively managed by closing the eyelids using tape [43,44], rather than using medical therapy, because of the risk of bacterial contamination of eye drops with prolonged use [45,46].…”

Section: Esteban Et Al (1978) [30]mentioning

confidence: 99%

Ocular surface lesions in clinical grades of Bell’s phenomenon

Faruk Yilmaz,

Oguz

2024

Med Hypothesis Discov Innov Ophthalmol

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Background: Bell’s phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical grading scale for Bell’s phenomenon that includes the inverse Bell’s phenomenon. Using this scale, we investigated the characteristics of Bell’s phenomenon among asymptomatic individuals in different age groups and examined the frequency of ocular surface lesions in asymptomatic and symptomatic participants with different grades. Methods: Bell’s phenomenon was classified into five grades: grade +2 (strong positive), grade +1 (weak positive), grade 0 (no Bell’s phenomenon, no eye movement), grade –1 (weak inverse), and grade –2 (strong inverse). In this cross-sectional study, we randomly included 330 eyes of 165 asymptomatic, healthy, White Turkish individuals who attended the outpatient eye clinic, with a male-to-female ratio of 1:1.4, in the control group. These were categorized into four age groups: 4 – 20 years, 21 – 40 years, 41 – 60 years, and > 60 years. Eighty eyes from 40 patients with ocular surface lesions and absence of grade +2 Bell’s phenomenon were included in the symptomatic group. Results: We detected higher frequencies of grade +2, +1, and 0 in individuals aged 4 – 40, 41 – 60, and > 60 years, respectively. There was a significant difference between age groups in the frequencies of different grades (P < 0.001). Pairwise analysis revealed a significantly lower frequency of grade +2 in the age group > 60 years compared with the 4 – 20 and 21 – 40 year groups (both P < 0.05). Grade +2 was the most frequent in both sexes. We detected grade 0 in 27.1% of men and 22.1% of women in the control group, with no significant difference in the frequencies of different grades between sexes (P > 0.05). We observed significant differences between grades with respect to the frequency of ocular surface lesions (P < 0.001). Pairwise analysis revealed a significantly higher frequency of ocular surface lesions in asymptomatic individuals with grade 0 and all four other grades (all P < 0.001). However, the frequency of ocular surface lesions was comparable between sexes (P > 0.05). Of the 40 symptomatic individuals, 28 (70%), 5 (12.5%), 4 (10%), and 3 (7.5%) had grade 0, +1, –1, and –2, respectively. The number of symptomatic patients was higher in grade 0 (n = 28) than in other grades (grade +1, –1, and –2: n = 12 patients), and these individuals had a higher frequency of ocular surface lesions (n = 38 lesions) than others (grade +1, –1, and –2: 7 lesions). Conclusions: Using a simple, practical grading scale for Bell’s phenomenon that includes inverse Bell’s phenomenon, we observed that inverse Bell’s phenomenon is a reflex that may be present in healthy individuals and could have a protective effect on the eye, although not to such a degree as a strong Bell’s phenomenon. Our observations imply that bilateral conjunctival calcifications/Vogt’s limbal girdle may be associated with grades 0 and +1 Bell’s phenomenon. Further large-scale studies are needed to determine the frequency of Bell’s phenomenon in the general population using this innovative, simple, practical grading scale, and to identify the protective or injurious effect of each grade on the ocular surface.

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Section: Esteban Et Al (1978) [30]mentioning

confidence: 99%

Ocular surface lesions in clinical grades of Bell’s phenomenon

Faruk Yilmaz,

Oguz

2024

Med Hypothesis Discov Innov Ophthalmol

Self Cite

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“…Especially products prepared onsite because they contaminate oxidizing agents, and negatively charged ions in water can convert BKC to an inactive form, causing antimicrobial activity eventually to decrease as a result [ 10 ]. In addition, benzalkonium chloride is also used as a preservative in the preparation of pharmaceutical products, such as ophthalmic drops and nasal sprays [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a sustainable procedure for smartphone-based colorimetric determination of benzalkonium chloride in pharmaceutical preparations

Katib,

Apichai,

Pattananandecha

et al. 2024

Heliyon

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“…Bacterial contamination rates of ophthalmic solutions range from 3% up to 35% in different settings. [6][7][8][9][10] Schein et al found a threefold increase of potentially pathogen microorganisms in the conjunctival flora among subjects under long-term drop, therapy postulating a contamination cycle between the eye-drop dispenser and the patient's conjunctiva. 11…”

Section: Introductionmentioning

confidence: 99%

Multiple use of preservative-free single dose unit dexamethasone 0.1% eye drops is safe within 24 hours

Fierz,

Locher,

Bachmann

et al. 2024

BMJ Open Ophth

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BackgroundUnpreserved single-dose unit (SDU) eye drops are commonly used to avoid benzalkonium chloride-related toxicity. Although intended for single use, many patients report off-label repeated use of SDUs over a prolonged period. We investigated whether repeated use of dexamethasone 0.1% SDUs in the same patient increases the bacterial contamination rate.MethodsWe prospectively enrolled patients scheduled for inpatient corneal and glaucoma surgery receiving dexamethasone 0.1% SDU four times per day from the same vial. To assess contamination rates, one drop from the vial was cultured immediately after opening the SDU (t0), 10 hours later after four drop applications (t10) and 24 hours after opening without further drop applications (t24). Conjunctival swabs were taken before and after drop application. Contamination rate was assessed with a standard clinical culturing protocol without introducing a positive control.Results110 eyes of 109 patients were evaluated. Drops collected immediately after opening the SDU (t0) were contaminated in 9/110 cultures (8.1%). At t10, 13/110 cultures were contaminated (11.8%; p=0.267) and 11/110 at t24 (10.0%; t24 vs t0; p=1.00). In 5 of 21 cases of contaminated drops at t10 and/or t24, the same isolates were cultured from the initial conjunctival swab and the SDU. In three cases, the same bacterial species was found in consecutive samples.ConclusionThe contamination rate of the SDU did not increase after multiple use within 24 hours. Contamination from fingertip flora was more likely than from ocular surface flora. Reuse of dexamethasone 0.1% SDU in the same patient within 24 hours appears to be safe.

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Bacterial contamination of multi-use antibiotic steroid eye ointments and drops

Cited by 6 publications

References 17 publications

Ocular surface lesions in clinical grades of Bell’s phenomenon

Ocular surface lesions in clinical grades of Bell’s phenomenon

Development of a sustainable procedure for smartphone-based colorimetric determination of benzalkonium chloride in pharmaceutical preparations

Multiple use of preservative-free single dose unit dexamethasone 0.1% eye drops is safe within 24 hours

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