Carmellose Sodium

Approved Indications:

• Dry Eye Syndrome (Keratoconjunctivitis Sicca): For the symptomatic relief of burning, irritation, and discomfort due to dryness of the eye or exposure to wind or sun.
• Ocular Surface Lubrication: In patients with insufficient tear production or meibomian gland dysfunction.
• Adjunct in Post-Surgical Healing: Following laser eye surgery or other ophthalmic procedures.
• Contact Lens-Associated Discomfort: As a lubricant during or after lens removal.

Clinically Accepted Off-Label Uses:

• Exposure Keratopathy: To reduce corneal drying in cases of incomplete eyelid closure.
• Chemical or Thermal Burns (Acute Phase): As part of eye protection strategy until healing progresses.

Adults:

• Usual dose: 1–2 drops in the affected eye(s), up to 4–8 times daily, depending on severity.
• Severe Dry Eye: May be used hourly or as directed by an ophthalmologist.

Pediatric Use:

• Safe and effective in children; use similar dosing to adults under medical supervision.

Elderly:

• No dose adjustment necessary; follow adult dosage recommendations.

Special Populations:

• Renal or Hepatic Impairment: No adjustment required; negligible systemic absorption.

Route of Administration:

• Topical (Ophthalmic): Instill into the conjunctival sac.
• Instructions: Wash hands prior to use. Avoid touching dropper tip to any surface. Wait at least 5 minutes between different eye medications if used concurrently.

Carmellose Sodium (carboxymethylcellulose sodium) is a high-viscosity, cellulose-derived polymer that acts as a tear film stabilizer and ocular lubricant. It mimics the mucin component of natural tears, enhancing adherence to the ocular surface and providing a moisture-retentive shield. This relieves irritation, dryness, and mechanical friction by reducing tear evaporation and increasing ocular hydration.

• Absorption: Minimal systemic absorption via ocular route.
• Distribution: Remains localized on the ocular surface; does not enter systemic circulation in significant amounts.
• Metabolism: Not metabolized in the eye.
• Excretion: Excess formulation drains via nasolacrimal duct; negligible systemic excretion.
• Onset of Action: Within minutes of administration.
• Duration of Effect: Variable, typically 1–2 hours depending on tear film stability and blinking rate.

• Pregnancy: Not assigned a specific FDA category. Available data suggest low risk when used ophthalmically. Use only if clearly needed.
• Lactation: Unlikely to affect breastfed infants due to negligible systemic absorption. Can be used safely during breastfeeding.
• Note: No adverse fetal or neonatal outcomes have been reported with topical ophthalmic use.

• Primary Class: Ophthalmic Lubricant
• Subclass: Artificial Tear Substitute / Ocular Demulcent

• Known hypersensitivity to Carmellose Sodium or any component of the formulation
• Active ocular infection (unless prescribed with supervision)
• Use of contaminated solution or product past expiry date

• Contamination Risk: Avoid touching the dropper tip to surfaces or the eye.
• Use with Contact Lenses: Some formulations may contain preservatives (e.g., benzalkonium chloride) that can discolor or damage lenses. Use preservative-free variants if applying while wearing lenses.
• Visual Disturbance: Temporary blurred vision may occur after instillation.
• Serious Conditions: If ocular pain, vision changes, continued redness, or irritation occur or persist for >72 hours, discontinue and consult an eye specialist.

Common:

• Temporary blurred vision
• Mild eye burning or stinging
• Eye discomfort or foreign body sensation

Uncommon:

• Allergic reaction (itching, redness, eyelid swelling)
• Increased eye discharge
• Eyelid crusting

Rare but Serious:

• Hypersensitivity reactions
• Severe conjunctival hyperemia
• Secondary microbial contamination (if used improperly)

• Drug–Drug: No significant systemic drug interactions due to minimal absorption.
• Drug–Preservative Interaction: If used with other ophthalmic drops (e.g., antibiotics or corticosteroids), administer 5–10 minutes apart.
• Contact Lens Interaction: Preservatives in some formulations may interact with soft contact lenses; avoid unless using preservative-free solutions.

• Preservative-Free Advancements: Increased availability of preservative-free unit-dose formats to minimize allergic responses.
• Guidelines (2024–2025): International Dry Eye Workshop (DEWS II) has reiterated the utility of high-viscosity agents like Carmellose Sodium in moderate to severe dry eye syndromes as first-line therapy.

• Temperature: Store below 25°C. Do not freeze.
• Light & Humidity: Keep in original container; protect from excessive moisture and light.
• Single-Use Vials: Discard immediately after use to prevent microbial contamination.
• Multi-Use Bottles: Discard within 30 days after opening (unless otherwise specified on packaging).
• Handling: Shake well if directed. Ensure cap is closed tightly after each use.