Abstract
Purpose: Preservative-free cationic emulsion-based artificial tear (AT) is an innovative eye drop based on the Novasorb® technology with cetalkonium chloride (CKC) as the cationic agent. The cationic emulsion Cationorm is designed for the management of mild-to-moderate dry eye disease (DED) patients that present cornea epithelium alterations. The aim of the present study was to evaluate the safety and tolerability of overdosed ATs by altered corneal epithelium in vivo and assess the usefulness of the ex vivo eye irritation test (EVEIT) as a predictive alternate toxicity test method.Methods: The experimental procedure, treatment duration, and instillation frequency closely mimic in vivo the ex vivo protocol described by Pinheiro et al. and discussed in the Discussion and Conclusion section of this article. Two to 3-month-old female New Zealand white rabbits, n = 6 per group, were treated with ATs (21 instillations/day over 3 days) following corneal abrasion. Corneal fluorescein staining, in vivo confocal microscopy (IVCM), and slit lamp examinations were performed to assess corneal epithelium recovery and the ocular tolerability of the overdosed ATs.Results: All abraded eyes experienced almost complete epithelium recovery within 3 days following treatments with Cationorm, Optive, Vismed, and Saline. Benzalkonium chloride (BAK, 0.02%) treatment resulted in 82.4% reepithelialization. IVCM data illustrated corneal epithelium normal recovery. Acute local tolerability of the overdosed ATs was confirmed using Draize and McDonald–Shadduck's test scales.Conclusions: The different ATs were demonstrated to be well tolerated by abraded corneas in vivo, and the extreme overdosing regimen did not hamper the wound healing process of the rabbit eye in comparison to saline. These data did not confirm the ones obtained with the nonvalidated ex vivo eye irritation test.
Highlights
IntroductionDry eye disease (DED) is a complex multifactorial disease of the ocular surface that manifests by structural alterations of the cornea (keratitis) and the presence of symptoms of discomfort of variable severity (scratchy and dryness sensation, stinging or burning, pain, and eye redness).[1]
Dry eye disease (DED) is a complex multifactorial disease of the ocular surface that manifests by structural alterations of the cornea and the presence of symptoms of discomfort of variable severity.[1]
Preservative-free cationic emulsion-based artificial tear (AT) is an innovative eye drop based on the NovasorbÒ technology with cetalkonium chloride (CKC) as the cationic agent
Summary
Dry eye disease (DED) is a complex multifactorial disease of the ocular surface that manifests by structural alterations of the cornea (keratitis) and the presence of symptoms of discomfort of variable severity (scratchy and dryness sensation, stinging or burning, pain, and eye redness).[1]. ATs exist with different formulation strategies used to restore a healthy TF.[7] Aqueous-based AT formulations, with or without gel-forming polymers (eg, carboxymethyl cellulose, hydroxypropyl guar, and hyaluronic acid), are classically used in aqueous-deficient DED,[8] while lipid-containing ATs are used for evaporative DED.[9,10,11] For the temporary relief of the less severe (ie, mild to moderate) symptoms, patients are advised to instill one drop in the affected eye when needed and up to 4 drops per day.[12] The demonstration of the efficacy and safety of most of the ATs was performed in 1–3 month clinical trials in mild-to-moderate
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