What is the indication for Hypromellose (hydroxypropyl methylcellulose)?

Hypromellose Indications

Hypromellose (hydroxypropyl methylcellulose) is indicated as an ocular lubricant to relieve dryness of the eye and prevent further irritation of the ocular surface. 1

Primary Clinical Indications

Dry Eye Disease

• Hypromellose-containing artificial tears are recommended as first-line therapy for patients with Sjögren's syndrome presenting with ocular dryness, applied at least twice daily with frequency increased up to hourly based on symptoms and objective signs. 2
• Preservative-free formulations are recommended for patients requiring four or more applications per day. 2
• For severe dry eye associated with Sjögren's syndrome, 0.5% hypromellose significantly improves rose bengal and fluorescein staining scores and tear breakup time. 3
• Hypromellose provides prolonged coverage of the ocular surface, with tear evaporation rates remaining reduced for 30 minutes after instillation. 3

Reflex Tearing from Ocular Surface Dysfunction

• The American Academy of Ophthalmology recommends initiating ocular lubricants such as hypromellose for patients with epiphora due to dry eye or meibomian gland dysfunction. 4
• Hypromellose should be combined with petrolatum ointment at night if nocturnal lagophthalmos exists. 4

Perioperative Eye Protection

During General Anesthesia:

• For at-risk surgery (head and neck procedures, ventral or lateral positioning), methylcellulose-containing lubricants in preservative-free single-dose form are recommended in combination with eyelid occlusion using adhesive strips. 2
• Methylcellulose produces fewer adverse effects than paraffin-based ointments, with lower rates of conjunctival oedema (5.5% vs 52%) and hyperaemia (3.7% vs 22%). 2

During Phacoemulsification:

• Intraoperative application of 2% hypromellose during phacoemulsification reduces the incidence of postoperative dry eye syndrome in both senile and diabetic patients. 5
• Hypromellose 2% maintains corneal hydration and significantly reduces the frequency of intraoperative irrigation applications. 5

In Intensive Care:

• For intubated and ventilated ICU patients, aqueous gels or humidity chambers are preferred over artificial tears alone to prevent exposure keratopathy. 2

Adjunctive Use in Bacterial Conjunctivitis

• Artificial tears containing hypromellose help dilute bacterial load and inflammatory mediators, providing symptomatic relief from irritation. 6
• Preservative-free formulations are preferred when frequent application is needed. 6
• Hypromellose should not replace appropriate antibiotic therapy but serves as adjunctive symptomatic treatment. 6

Formulation Selection

Eye Drops vs. Ointments

• Eye drops are preferred for daytime use when clear vision is required, with dosing 2-4 times daily for mild-to-moderate dry eye. 7
• Ointments are reserved for nighttime use or severe corneal conditions requiring prolonged ocular surface contact. 7
• The American College of Ophthalmology advises against using ointments during daytime activities requiring clear vision due to significant blurring. 7

Common Pitfalls to Avoid

• Hypromellose provides symptomatic relief but does not restore normal tear film stability or conjunctival epithelial surface ultrastructure in established dry eye disease. 8
• Chronic use without addressing underlying ocular surface disease may delay appropriate anti-inflammatory treatment (cyclosporine, lifitegrast) when indicated. 4
• Multi-dose bottles with preservatives cause irritation with frequent use; switch to preservative-free formulations when dosing exceeds 4 times daily. 2, 7
• In surgical settings, hypromellose has not been proven superior to air for protecting corneal endothelium during intraocular lens implantation, so its use should be confined to specific situations like bound-down pupils. 9