What is the recommended usage and dosage of Dextran 70-hypromellose solution?

Dextran 70-Hypromellose Ophthalmic Solution

Recommended Usage and Dosage

Instill one or two drops in the affected eye(s) as needed for symptomatic relief of dry eye symptoms. 1

Active Ingredients

The FDA-approved formulation contains:

• Dextran 70: 0.1% 1
• Hypromellose: 0.3% 1

Clinical Indications

This combination artificial tear solution is indicated for:

• Symptomatic relief of dry eye disease 2, 3
• Post-operative dry eye following cataract surgery 3
• Ocular surface lubrication and protection 2

Dosing Frequency

• Apply as needed throughout the day based on symptom severity 1
• No maximum daily dose is specified in FDA labeling, allowing flexible use based on patient symptoms 1
• Patients typically use 1-2 drops per affected eye multiple times daily 2

Clinical Efficacy Evidence

Comparative Effectiveness

• Both preserved and preservative-free formulations demonstrate equivalent efficacy in improving OSDI scores, conjunctival staining, and corneal staining scores after 4 weeks of use 2
• Dextran-70 eye drops are less effective than sodium hyaluronate or polyethylene glycol for post-phacoemulsification dry eye, with higher incidence of persistent dry eye symptoms (39.39% vs 12.12% and 18.18% respectively) 3
• Tear breakup time, corneal staining scores, and Schirmer I test results are inferior with dextran-70 compared to sodium hyaluronate or polyethylene glycol at all time points from 3 to 60 days post-operatively 3

Formulation Considerations

Preservative-Free vs Preserved

• Preservative-free single-dose formulations contain dextran 70 1mg/ml and hypromellose 3mg/ml 2
• Multi-dose preserved formulations contain 0.3g hypromellose and 0.1g dextran 70 with 0.01% benzalkonium chloride (BAK) 2
• Both formulations show statistically equivalent improvements in dry eye parameters, though preservative-free may be preferred for patients with BAK sensitivity 2

Clinical Pitfalls and Caveats

• Consider alternative agents for post-surgical dry eye: Sodium hyaluronate or polyethylene glycol demonstrate superior outcomes compared to dextran-70 formulations in the post-phacoemulsification setting 3
• No improvement in tear production: Schirmer test scores do not significantly improve with dextran-70/hypromellose treatment, indicating this is primarily a lubricant rather than a tear secretagogue 2
• Symptom-based dosing: Since no maximum frequency is specified, patients should be counseled to use as frequently as needed for comfort without concern for overdosing 1

Administration Technique

• Instill drops directly onto the ocular surface 1
• Avoid touching the dropper tip to any surface to prevent contamination 1
• If using multiple ophthalmic medications, wait at least 5 minutes between different eye drop applications 1