It feels good for 10 minutes, after that it gets dry and weird and you wish you didn't use it and generated yawn tears yourself with 2100 chemicals and custom made for your eyes. :) Definitely, this is not the nice feel of Hylo Forte, Hylo Tear, clear Eyes Advanced, Optase, etc. It feels like the mineral oils in it are not that great. Mineral oils are not natural lipids found in human eyes.
0.5% mineral oil, 0.5% light mineral oil, 2% (Table 1 of J Ocul Pharmacol Ther. 2017; 33(9): 647â€"61., free PubMed paper, has w/w %) glycerin, Tris buffer, 0.2% tyloxapol to inhibit bacteria secreted lipases (bacteria break the tear lipid layer), 0.01% poloxamer 188. Box lists cetalkonium chloride (0.005%) CKC as “inactive ingredient” of “unpreserved” drops, but it is a name for a BAK component (the most lipophilic), sort of like “water bottle is BPA free, it just has BPA derivative that is 10% more/less toxic”; the cetalkonium is BAK where the alkyl group is C16H33; cetalkonium (BAC16 as they call it) was found to be, in vitro, very toxic, making 93% of corneal cells unviable, while BAK 100%; however, in vivo, not all BAKs have the same toxicity (BAC8,10,12,14,16,18), so maybe that's why they use it, Cationorm (same product) uses it too. “Retaine™ (marketed outside the US as Cationorm®, Santen, Osaka, Japan)” â-º Clin Oph 2015;9:235-43. It is made by Novagali Pharma, a French company acquired by Santen Japan in 2011. Rat (not human) studies can be funded by BAC16 makers so it looks BAK lowers goblet (mucin tear layer cells; low goblet=dry eye) cell count 37.5%, but Cationorm (in spite of BAC16 or due to using BAC16 instead of BAC8-18 mix?) increases it 40%; BAC16 is 5% of the BAK mix usually per Wikipedia. I tried it 9-5-21 1st time, after 8 hours of no drops/no saline showed some mild eye reddening on both eyes and irritation, sting on the left eye; no surprise since BAK is the world's most toxic, irritating preservative. I used Clear Eyes Advanced 5 min after, after washing with saline and eyes felt so much better. On 9-8-21 I tested it 4 times over 5 h; when I used two drops, eyes got a little red, and all the white lipids formed a white clump outside the eye corner, due to blinking pushing everything; then 15 min later, there were tiny stings in the nasal corner, as it happens with other drops when eye is tired on 2nd drop; due to 4 tests, being 7 pm 4th time, the toxicity of BAK/Tris spoke. Tris is a buffer not found in natural tears, so it may cause issues for some.
the pH of this is 7.1 per this paper, J Ocul Pharmacol Ther. 2016; 32(2): 109â€"18.Table 1, google it, it's a free PubMed paper. being emulsion with pH papers at home I could not confirm this pH value, being random and all over the place, but lower than 6.7, hence 7.1 may be true, if they used a good instrument for emulsions.
I don't know what to make of it, except it's deceptive marketing and the only US drop with lipids that uses Tris buffer, all the rest using boric acid.
Mineral oils got impurities and aromatic hydrocarbons that irritate and redden the eye (all ointments at times, when used even in tiny amounts, way less than what paper says, cause some irritation). Also, their biophysical properties are different: pretty solid at room temp, while healthy meibum is liquid. Due to different electrostatic biophysical properties, they could alter the fine balance of the chemical system of the tears and disturb the homeostasis of the aqueous-lipid layer barrier (plug some outer lipid layer holes, but disturb the inner lipid layer stability where phospholipids face the water; i.e. reality being different than theory sometimes, not having such a universal ‘all good effect' on 3rd lipid layer stability), or by facilitating certain toxic compounds to more easily cross the junction points between layers of the eye: cornea-vitreous gel, vitreous gel-retina, etc. Additionally, most hydrocarbons believed to be natural to meibum are squalene, which is similar to beta carotene, etc, vastly different than the saturated alkanes in mineral oils. Many authors think the alkanes found in some meibum studies are due to people using face cream, makeup, etc and these entering meibomian glands (or mineral oils in every hand cream and shampoo, in food, etc), where, via different biophysical properties they can slow down certain important regenerative processes, leading to the meibomian gland lipid underproduction or even atrophy in the long-term, while offering short-term protection â€" just like redness reliever eye drops offer ‘white eyes' today, but rebound redness 2 years later and damaged blood vessels (by contracting and expanding 1-2 times daily for 3 years) when eyes no longer respond well and we need 5x more of a very acidic drop to prevent redness that destroys the eye since only around pH 7.4-7.6 some eye processes of regeneration are optimal apparently in vitro, not at 5.7-6.3 of redness reliever drops. Thus, not all is rosy just because ‘alkanes don't chemically react with anything', they could change electric potentials across membranes, block certain enzymes from folding, proteins, etc, slowing thus important biochemical processes. Being solid vs natural healthy meibum, they are introducing cytokine storm via the ‘foreign body' sensation they can cause in the first minutes of application. “Pharmaceutical grade mineral oil consists of a mixture of saturated hydrocarbons” â-º EHJS 2020;22(Suppl J):J34-8. Vaseline (Eur. Ph.) can have 0.67% aromatics, while light liquid or liquid paraffin more like 0.05% â-º F1000Res 2017;6:682.
Why not buy Bausch and Lomb Soothe ointment with just 20% mineral oil and 80% white petrolatum (pure hydrocarbons, like Walgreens PM ointment made in the USA with the same exact ingredients) instead of placing this toxic BAK in our eyes?
Anyway, let's see what others have to say. :) Just some papers on BAK preservative:
“incidence of pain and discomfort reducing from 52.4% to 7.8% following use of preservative-free compared to preserved drops... lower levels of burning/ stinging (40% vs 22%), dry eye sensation (23% vs 14%), foreign body sensation (31% vs 14%)... After a minimum 3-week switch to a preservative-free artificial tears, Ocular Surface Disease Index (OSDI) scores were significantly reduced for 97% of the patients, along with a reduction in the frequency of superficial punctate keratitis” â-º Clin Ophthal 2019;13:1409-25. However, some companies use marketing scams to call preserved drops as unpreserved; also some inactive ingredients combined can be more deadly than the least damaging preservatives as explained in the next 25 pages. The buffers, polymers used as lubricants, emulsifiers, etc are also toxic “the ideal artificial lubricant should be preservative-free... Preservative-free formulations are absolutely necessary for patients with severe dry eye..” â-º The Ocular Surface 2007;5(2):69-204, the DEWS (Dry Eye WorkShop) Report (142 page PDF; this long PDF explains how eye drops are formulated, how toxic some ingredients are). The most toxic preservative is BAK (benzalkonium chloride, for short, or alkyl dimethylbenzyl ammonium chloride, the correct name, with alkyl C8H17 to C18H37; Biocontrol Sci 2011;16(3):117-21 found 0.01% BAK (used in many eye drops) is far more toxic than boric acid 1% (eye drops boric is 0.1% as part of buffer); BAK was worse than polysorbate 80 which is itself far more toxic than boric acid, about 30-40% of conjunctiva cells died]. JOPT 2009;25(2): 13-9 found in vitro toxicity at artificial tear concentrations for cornea/conjunctiva cells to reach 6-59% for 0.01% EDTA (chelates metals, so inhibits metalloproteases on the ocular surface), 23-59% for 0.0025% perborate Na2[B2O4(OH)4] (banned in EU, not boric/borate, but used in US eye gels like Systane), 30-60% for 0.01% methylparaben, 50-86% for 0.25% chlorobutanol, 56-89% for 0.025% BAK (thankfully, at 0.01% usually), 70-95% for 0.0025% thimerosal mercury compound which is deadly, since mercury destroys nerves
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