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Sunday, July 27, 2025

Carmellose sodium eye drops


Carmellose sodium (also known as carboxymethylcellulose sodium) eye drops are artificial tear substitutes widely used to treat dry eye syndrome, ocular irritation, and various forms of non-infective ocular surface discomfort. They are available in preserved and preservative-free formulations, and in varying viscosities depending on the severity of dryness. Carmellose sodium is among the most prescribed lubricating agents due to its strong water-retentive capacity and long-lasting moisture protection.

Pharmacological Classification

  • Therapeutic class: Ocular lubricant (artificial tears)

  • Pharmacologic class: Viscoelastic polymer (cellulose derivative)

  • ATC Code: S01XA20

Brand Names and Formulations

  • Celluvisc®, Optive®, Refresh Tears®, Vistilube®, Tears Naturale®, TheraTears®, Carmize®

  • Available in unit-dose vials (preservative-free) and multi-dose bottles (with preservatives)

  • Viscosity options:

    • 0.5% Carmellose sodium: standard formulation for mild-to-moderate dry eyes

    • 1.0% or higher: for severe dry eye or overnight use

Mechanism of Action

Carmellose sodium is a hydrophilic, high molecular weight polymer derived from cellulose. It acts as a tear film stabilizer and ocular surface lubricant by:

  • Forming a protective, viscoelastic film over the corneal surface

  • Increasing the residence time of tears and moisture on the ocular epithelium

  • Reducing tear evaporation and ocular friction

  • Mimicking the aqueous component of natural tears

  • Enhancing epithelial healing and relieving irritation

It does not have pharmacological activity in terms of antimicrobial, vasoconstrictive, or anti-inflammatory actions, but its physical properties provide significant symptom relief.

Clinical Indications

Carmellose sodium eye drops are indicated for:

Approved Uses

  • Dry eye disease (keratoconjunctivitis sicca)

  • Ocular surface irritation from wind, sun, pollution, screen use

  • Contact lens–related dryness (only if specified as lens-compatible)

  • Ocular fatigue

  • Post-operative lubrication (e.g., after cataract or LASIK surgery)

  • Lagophthalmos, blepharitis, or meibomian gland dysfunction

Off-label Uses

  • Supportive therapy for exposure keratopathy

  • Sjogren’s syndrome–associated dry eyes

  • Preservative-free formulations used in neurotrophic keratitis or severe ocular surface disease

Dosage and Administration

  • Adults and Children:

    • Instill 1–2 drops into the affected eye(s) as needed

    • Typically used 2–4 times daily, but may be used hourly in severe cases

    • For overnight protection, thicker gel-forming drops or ointments may be used in addition

  • Preservative-free unit doses:

    • Discard immediately after single use

    • Ideal for frequent use or sensitive eyes

  • With preservatives (e.g., benzalkonium chloride):

    • Limit frequency (typically ≤4 times/day) to avoid epithelial toxicity

    • Not recommended in long-term or intensive use

  • Contact lenses:

    • Remove lenses before application unless product is contact lens–compatible

    • Wait at least 15 minutes before reinserting lenses

Contraindications

  • Known hypersensitivity to carmellose sodium or any component of the formulation

  • Preservative-containing formulations should be avoided in:

    • Severe dry eye disease

    • Ocular surface inflammation

    • Contact lens users (unless specified as safe)

Precautions and Warnings

  • Avoid contamination: Do not touch the dropper tip to any surface, including the eye

  • Use preservative-free drops in:

    • Chronic ocular conditions

    • Post-surgical recovery

    • Immunocompromised patients

  • Blurred vision may occur temporarily after instillation; avoid driving immediately after use

  • Do not use expired product or opened single-dose vials after 24 hours

  • If irritation or worsening symptoms occur, discontinue use and consult a clinician

Side Effects

Common (1–10%)

  • Transient blurred vision

  • Eye discomfort or burning on instillation

  • Foreign body sensation

Uncommon (<1%)

  • Allergic conjunctivitis

  • Eyelid swelling or irritation

  • Increased tearing

  • Stinging sensation

Rare

  • Hypersensitivity reactions

  • Preservative toxicity with long-term use of BAK-containing products:

    • Chronic irritation

    • Corneal epithelial damage

    • Follicular conjunctivitis

Drug Interactions

  • No systemic drug interactions due to local action and lack of systemic absorption

  • May interfere with absorption of other topical ophthalmic drugs:

    • Administer other eye drops at least 5–10 minutes apart

    • Use carmellose last if possible to avoid washout of active drugs

Pregnancy and Lactation

  • Pregnancy:

    • Not systemically absorbed; no known teratogenicity

    • Safe to use as per available data

  • Lactation:

    • No measurable levels in breast milk

    • No known harm to nursing infant

Use in Special Populations

  • Elderly: Well tolerated

  • Pediatrics: Safe in children; no dosage adjustment needed

  • Post-surgical patients: Preferred choice when preservative-free

  • Patients with ocular surface disease: Use unit-dose preservative-free options

Patient Counseling Points

  • Wash hands before and after use

  • Tilt head back and pull down lower eyelid to form a pocket

  • Instill drops and close eyes gently for 1–2 minutes

  • Avoid blinking or rubbing the eye after instillation

  • Use before sleep if needed for overnight dryness

  • For contact lens wearers, only use lens-compatible products and follow specific guidelines

  • Do not reuse single-dose containers

  • Store at room temperature unless otherwise specified; refrigerate if recommended

  • Keep away from light and moisture

Advantages of Carmellose Sodium over Other Artificial Tears

  • Longer ocular retention time than hypromellose

  • Better ocular surface hydration than polyvinyl alcohol

  • Minimal systemic absorption

  • Compatible with sodium hyaluronate in combination products

  • Available in preservative-free formulations, which are safer for long-term use




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