Aim: This study aimed to investigate acute corneal toxicity of commercially available diquafosol 3% ophthalmic solution (Diquas®), which contains C12 benzalkonium chloride (BAC) as a preservative. Methods: Corneal transepithelial electrical resistance (TER) changes after a 60-second exposure to Diquas® (diquafosol 3% preserved with 0.0075% C12 BAC); 0.0075% C12 BAC and 0.0075% C12, C14, C16 BAC mixture were measured in living rabbits. Corneal damage was also examined by scanning electron microscopy (SEM). Hank's balanced salt solution (HBSS) was used as a control. Results: Diquas® and 0.0075% C12 BAC did not produce any significant decrease in the corneal TER as compared to the HBSS control eyes. There was a significant decrease in the corneal TER after exposure of the cornea to the 0.0075% C12, C14, C16 BAC mixture (p < 0.01). SEM revealed that the superficial cells of the corneas exposed to the 0.0075% BAC mixture were damaged and exhibited degenerated microvilli. Conversely, the superficial cells of corneas exposed to Diquas® or 0.0075% C12 BAC appeared normal and had normal microvilli under SEM examinations. Conclusion: The acute corneal toxicity of Diquas® is less than that of the 0.0075% BAC mixture. Diquas® preserved with 0.0075% C12 BAC did not show acute corneal toxicity.

1.
International Dry Eye WorkShop. 2007 Report of the International Dry Eye WorkShop (DEWS). Ocular Surf 2007;5(special issue):65-202. http://www.theocularsurface.com/userfiles/file/DEWS.pdf (accessed June 7, 2014).
2.
Management and therapy of dry eye disease: report of the management and therapy subcommittee of the international dry eye workshop (2007). Ocul Surf 2007;5:163-178.
3.
Murakami T, Fujihara T, Nakamura M, et al: P2Y(2) receptor elicits PAS-positive glycoprotein secretion from rabbit conjunctival goblet cells in vivo. J Ocul Pharmacol Ther 2003;19:345-352.
4.
Murakami T, Fujihara T, Horibe Y, et al: Diquafosol elicits increases in net Cl- transport through P2Y2 receptor stimulation in rabbit conjunctiva. Ophthalmic Res 2004;36:89-93.
5.
Takaoka-Shichijyo Y, Nakamura M: Stimulatory effect of diquafosol tetrasodium on the expression of membrane binding mucin genes in cultured human corneal epithelial cells. Atarashii Ganka (J Eye) 2011;28:425-429.
6.
Takamura E, Tsubota K, Watanabe H, et al: A randomised, double-masked comparison study of diquafosol versus sodium hyaluronate ophthalmic solutions in dry eye patients. Br J Ophthalmol 2012;96:1310-1315.
7.
Tauber J, Davitt WF, Bokosky JE, et al: Double-masked, placebo-controlled safety and efficacy trial of diquafosol tetrasodium (INS365) ophthalmic solution for the treatment of dry eye. Cornea 2004;23:784-792.
8.
Matsumoto Y, Ohashi Y, Watanabe H, et al: Efficacy and safety of diquafosol ophthalmic solution in patients with dry eye syndrome: a Japanese phase 2 clinical trial. Ophthalmology 2012;119:1954-1960.
9.
Yerxa BR, Douglass JG, Elena PP, et al: Potency and duration of action of synthetic P2Y2 receptor agonists on Schirmer scores in rabbits. Adv Exp Med Biol 2002;506(pt A):261-265.
10.
Murakami T, Fujita H, Fujihara T, et al: Novel noninvasive sensitive determination of tear volume changes in normal cats. Ophthalmic Res 2002;34:371-374.
11.
Fujihara T, Murakami T, Fujita H, et al: Improvement of corneal barrier function by the P2Y(2) agonist INS365 in a rat dry eye model. Invest Ophthalmol Vis Sci 2001;42:96-100.
12.
Norn MS, Opauszki A: Effects of ophthalmic vehicles on the stability of the precorneal film. Acta Ophthalmol (Copenh) 1977;55:23-34.
13.
Saarinen-Savolainen P, Järvinen T, Araki-Sasaki K, et al: Evaluation of cytotoxicity of various ophthalmic drugs, eye drop excipients and cyclodextrins in an immortalized human corneal epithelial cell line. Pharm Res 1998;15:1275-1280.
14.
Debbasch C, Brignole F, Pisella PJ, et al: Quaternary ammoniums and other preservatives' contribution in oxidative stress and apoptosis on Chang conjunctival cells. Invest Ophthalmol Vis Sci 2001;42:642-652.
15.
Dormans JA, van Logten MJ: The effects of ophthalmic preservatives on corneal epithelium of the rabbit: a scanning electron microscopical study. Toxicol Appl Pharmacol 1982;62:251-261.
16.
Nakashima M, Nakamura T, Teshima M, et al: Breakdown evaluation of corneal epithelial barrier caused by antiallergic eyedrops using an electrophysiologic method. J Ocul Pharmacol Ther 2008;24:43-51.
17.
Uematsu M, Kumagami T, Kusano M, et al: Acute corneal epithelial change after instillation of benzalkonium chloride evaluated using a newly developed in vivo corneal transepithelial electric resistance measurement method. Ophthalmic Res 2007;39:308-314.
18.
Kusano M, Uematsu M, Kumagami T, et al: Evaluation of acute corneal barrier change induced by topically applied preservatives using corneal transepithelial electric resistance in vivo. Cornea 2010;29:80-85.
19.
Uematsu M, Kumagami T, Shimoda K, et al: Influence of alkyl chain length of benzalkonium chloride on acute corneal epithelial toxicity. Cornea 2010;29:1296-1301.
20.
Baudouin C, Labbé A, Liang H, et al: Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res 2010;29:312-334.
21.
Chrai SS, Patton TF, Mehta A, et al: Lacrimal and instilled fluid dynamics in rabbit eyes. J Pharm Sci 1973;62:1112-1121.
22.
Draize JH, Woodard G, Calvery HO: Methods for the study of irritation and toxicity of substances applied topically to the skin and mucous membranes. J Pharmacol Exp Ther 1944;82:377-390.
23.
Kruszewski FH, Walker TL, DiPasquale LC: Evaluation of a human corneal epithelial cell line as an in vitro model for assessing ocular irritation. Fundam Appl Toxicol 1997;36:130-140.
24.
Furrer P, Plazonnet B, Mayer JM, et al: Application of in vivo confocal microscopy to the objective evaluation of ocular irritation induced by surfactants. Int J Pharm 2000;207:89-98.
25.
Monti D, Chetoni P, Burgalassi S, et al: Increased corneal hydration induced by potential ocular penetration enhancers: assessment by differential scanning calorimetry (DSC) and by desiccation. Int J Pharm 2002;232:139-147.
26.
Sasaki H, Yamamura K, Mukai T, et al: Enhancement of ocular drug penetration. Crit Rev Ther Drug Carrier Syst 1999;16:85-146.
27.
Ishibashi T, Yokoi N, Kinoshita S: Comparison of the short-term effects on the human corneal surface of topical timolol maleate with and without benzalkonium chloride. J Glaucoma 2003;12:486-490.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.