Eye Relief

Irrigating Solutions are sterile liquids primarily used to cleanse, hydrate, and cool tissues during surgical, diagnostic, or wound-care procedures. They are not intended for systemic use. Specific indications vary depending on the type of irrigating solution used, but include:

A. Ophthalmic Irrigating Solutions

• Intraocular hydration during cataract surgery or intraocular lens (IOL) implantation.
• Protection of corneal endothelium during ocular surgery.
• Removal of blood, viscoelastic substances, or debris from intraocular tissues.

B. Urological Irrigating Solutions

• Bladder irrigation during transurethral resection of the prostate (TURP) or bladder tumors.
• Prevention of clot retention or obstruction in catheterized patients.
• Irrigation during endoscopic urologic procedures.

C. General Surgical & Wound Irrigation

• Cleansing and debridement of wounds, burns, lacerations, or surgical incisions.
• Removal of foreign material, bacteria, and necrotic tissue.
• Intraoperative irrigation to reduce infection risk.

D. Ear, Nasal, and Sinus Irrigation

• Removal of cerumen or debris from the ear canal.
• Sinus irrigation to relieve congestion or post-surgical cleansing.

General Guidelines:

• Route: External use only (topical, intraoperative, intraocular, urologic, ENT).
• Frequency: As directed by the procedure or clinician; may be continuous or intermittent.
• Volume: Varies by procedure (from 10 mL to several liters).
• Temperature: Typically used at room or body temperature.

A. Ophthalmic Use:

• Use 15–50 mL of sterile balanced salt solution or lactated Ringer’s solution during surgery.
• Administer using sterile cannula/syringe under aseptic conditions.

B. Urological Use:

• Continuous bladder irrigation: 1–3 liters of 0.9% Sodium Chloride, Glycine 1.5%, or Sorbitol 3%.
• Flow rate controlled via gravity or irrigation pump.

C. Wound Care:

• Volume depends on wound size and contamination.
• Apply using a sterile squeeze bottle, bulb syringe, or pulsed lavage.

D. Ear/Nasal Irrigation:

• 5–30 mL of isotonic saline or sterile water, 1–2 times daily or as needed.

Note: Solutions must be used within a defined period after opening (usually 24 hours if aseptic technique is not strictly maintained). Do not use irrigating solutions containing preservatives for intraocular or cerebrospinal procedures.

Irrigating solutions act via mechanical flushing, removing debris, blood, microorganisms, or tissue remnants from a surgical or anatomical site. Some formulations mimic physiological fluids (e.g., balanced salt solutions for eyes), maintaining osmotic balance and protecting delicate tissues. They do not exert pharmacologic effects systemically but are essential in maintaining visibility, tissue hydration, and reducing contamination during procedures.

• Absorption: Minimal to none; not intended for systemic absorption.
• Distribution: Local effect only; does not enter systemic circulation under normal use.
• Metabolism: Not applicable.
• Elimination: Excess solution is removed by suction, drainage, or natural egress (e.g., bladder drainage, wound leakage).
• Bioavailability: Not systemically bioavailable.
• Onset of Action: Immediate mechanical effect upon application.
• Half-life: Not applicable (non-systemic).

• Pregnancy: As irrigating solutions are not absorbed systemically, they are generally considered safe in pregnant women when used as intended. However, solutions containing additives or preservatives may pose theoretical risks and should be avoided during intrauterine or obstetric procedures unless specifically approved.
• Lactation: No expected effect on breastfeeding or the breastfed infant due to minimal systemic absorption.
• Caution: Always assess the specific solution formulation (e.g., additives, osmolarity) before use in pregnant or lactating women.

• Primary Class: Surgical/Procedural Adjunct (Irrigating Agent)
• Subclasses:
• Ophthalmic irrigating solution
• Urological irrigating solution
• Wound/ear/nasal irrigants

• Hypersensitivity to any component of the irrigating solution (e.g., preservatives, additives).
• Use in closed body cavities (e.g., peritoneal space) unless specifically formulated for such use.
• Non-sterile solutions for intraocular or neurosurgical use.
• Use in intravenous administration (not approved for IV use).
• Presence of systemic infection risk when aseptic technique cannot be ensured.

• Aseptic Technique: Critical when used intraocularly or in surgical procedures.
• Preservatives: Only preservative-free solutions should be used in intraocular or spinal procedures.
• Electrolyte Imbalance: Large-volume irrigation (e.g., during TURP) may cause dilutional hyponatremia or fluid overload, especially with hypotonic solutions.
• Monitoring: Monitor fluid balance and serum electrolytes in procedures requiring large-volume irrigation.
• Contamination Risk: Discard unused solution after opening unless multi-dose use is explicitly allowed and sterility is preserved.

While irrigating solutions are generally well tolerated when used correctly, the following may occur:

A. Local Effects

• Transient stinging or burning (ear/nasal irrigation)
• Mild discomfort or pressure during irrigation
• Chemical irritation (if non-isotonic or contaminated)

B. Systemic Effects (Rare, Usually Due to Absorption of Large Volumes)

• Fluid overload (pulmonary edema, especially in cardiac/renal impairment)
• Electrolyte disturbances (e.g., hyponatremia)
• Hemolysis (hypotonic solutions in vascular access)
• Infection (from contaminated solutions)

C. Serious Adverse Events

• Toxic anterior segment syndrome (TASS) from contaminated intraocular solution
• TURP syndrome (hyponatremia, CNS symptoms) with excessive absorption of non-electrolyte irrigation fluids

Irrigating solutions have minimal to no systemic interaction potential, but some considerations include:

• Electrolyte Solutions + Diuretics/ACE Inhibitors: Risk of electrolyte imbalance if large volumes are absorbed.
• Solutions with Additives: Some solutions may contain antiseptics or buffering agents—interactions may occur with other topical agents.
• Sodium-containing Irrigants: May interfere with serum sodium measurements during surgical procedures if absorbed systemically.

• Intraocular Surgery: Regulatory emphasis on using only preservative-free, isotonic, pH-balanced solutions.
• Urological Guidelines: Recent consensus reinforces the use of isotonic saline over glycine/sorbitol in TURP to minimize electrolyte complications.
• Wound Irrigation: Updated wound care guidelines recommend sterile normal saline over antiseptic irrigants for most acute and chronic wounds to reduce tissue cytotoxicity.
• Pediatric Use: Greater caution advised in infants and neonates due to potential fluid absorption during large-volume irrigation.

• Temperature: Store between 15°C and 30°C (59°F to 86°F)
• Light Protection: Protect from excessive light and heat.
• Humidity: Keep container tightly closed in a dry place.
• Handling Precautions:
• Do not freeze.
• Use only clear solutions; discard if cloudy or discolored.
• Discard unused portions within 24 hours of opening unless otherwise specified.
• Sterility: Single-use containers are preferred for critical procedures (e.g., intraocular surgery).
• Reconstitution: Not applicable for most ready-to-use solutions; follow manufacturer instructions if concentrate or powder forms are used.