Sterile Compounding : Ophthalmics
Injectables | Ophthalmics | Erectile Dysfunction | Veterinary
We can compound sterile ophthalmic drops, ointments, sprays, injections and pre-op solutions, including anesthetics, antibiotics, antioxidants, antivirals, cataract therapies, corticosteroids, ophthalmic decongestants, miotics, mydriatics, and lubricants.
Preparations can contain a single drug or a combination in the most appropriate strength and concentration for a specific use, such as fortified antibiotic or pre-op drops.
Examples of preservative-free preparations include drops or sprays containing the following medications, alone or in combination:
- Cyclopentolate
- Homatropine
- Phenylephrine
- Proparacaine
- Scopolamine
- Tetracaine
- Tropicamide
We use only the highest quality ingredients from an FDA-approved supplier. Ask us about medications that are commercially unavailable or have been discontinued (for reasons other than safety concerns). We welcome the opportunity to answer your questions, and to work with you to compound medications that meet the specific needs of your practice. Please contact our compounding pharmacist with questions or to discuss any unique needs.
Autologous Serum Eye Drops
Conventional treatment of dry eye mainly consists of the use of preservative-free artificial eye drops and punctal occlusion. None of the commercially available artificial tear preparations include essential tear components such as epidermal growth factor, hepatocyte growth factor, fibronectin, neurotrophic growth factor, and vitamin A - all of which have been shown to play important roles in the maintenance of a healthy ocular surface epithelial milieu. Autologous serum (AS) eye drops contain these essential factors and are beneficial in the treatment of ocular surface diseases such as persistent epithelial defects (PED), superior limbic keratoconjunctivitis, keratoconjunctivitis sicca, and neurotrophic keratopathy. AS treatment has been demonstrated to be more effective than artificial tears in a randomized control study. In in vivo and in vitro experiments, AS eye drops showed marked suppression of apoptosis in the conjunctival and corneal epithelium. Albumin, the major protein in serum, improved ocular surface damage in vivo and rescued apoptosis after serum deprivation in vitro.
Autologous serum eye drops are non-allergenic and their biomechanical and biochemical properties are similar to normal tears. The protocol by Tsubota and associates entails obtaining a total of 40 ml of blood by venopuncture and centrifuging for 5 minutes at 1,500 rpm. The serum is then carefully separated in a sterile manner and diluted with sterile saline (preservative free) to prepare 20-50% autologous serum drops. Typically, aliquots of the final preparation are prepared in 5 ml vials with ultraviolet light protection, because vitamin A is easily degraded by light. Patients are instructed to keep the vials they are using in a refrigerator at 4 C and to store the other vials in a freezer until needed.
In the study by Kojima et al., none of the patients had punctal occlusion, which allowed evaluation of the solitary effect of autologous serum drops. They found significant improvements in tear stability, ocular surface vital staining scores, and pain symptom scores in patients treated with autologous serum eyedrops compared with those assigned to nonpreserved artificial tears; and concluded that autologous serum is superior to conventional treatment with artificial tears for improving ocular surface health and subjective comfort.3
1 Optom Vis Sci. 1997 Mar;74(3):160-3.
Efficacy of a mydriatic spray in the pediatric population.
Click here to access the PubMed abstract of this article.
2 Binocul Vis Strabismus Q. 1999;14(2):107-10
A randomized comparison study of drop versus spray topical cycloplegic application.
Click here to access the PubMed abstract of this article.
3 Am J Ophthalmol. 2005 Feb;139(2):242-6
The effect of autologous serum eyedrops in the treatment of severe dry eye disease: a prospective randomized case-control study.
Click here to access the PubMed abstract of this article.
Cycloplegic (Mydriatic) Eye Spray
Children often resist instillation of mydriatic drops for dilated fundus evaluation. As cycloplegic sprays have proven useful, two studies in children aged 3-13 years, compared administration of one drop each of 1% tropicamide and 2.5% phenylephrine in each eye or one application of mydriatic spray (containing concentrations of 0.5% tropicamide and 2.5% phenylephrine) to each closed eyelid. These studies indicate that use of mydriatic sprays on closed eyelids is as efficacious as use of mydriatic drops in open eyes, and is a preferred method of administration for children. 1,2
Because mydriatic sprays are compounded, the physician has flexibility in prescribing the concentration and combinations of medications, and may also include homatropine, scopolamine or proparacaine.
1Optom Vis Sci. 1997 Mar;74(3):160-3.
Efficacy of a mydriatic spray in the pediatric population.
Click here to access the PubMed abstract.
2Binocul Vis Strabismus Q. 1999;14(2):107-10
A randomized comparison study of drop versus spray topical cycloplegic application.
Click here to access the PubMed abstract.
Combination Therapy / Pre-op Drops
Many procedures call for multiple eye drops administered in a short period of time.The problem is that consecutive drops wash out and dilute the preceding medication, causing decreased effectiveness and repeated administration. While some clinics will mix all of the drops together (slurry) before administration, this results in a significant dilution of active ingredients from their therapeutic concentration. We can prepare combination eye drops that maintain the original therapeutic concentration in each drop. In addition, the viscosity can be increased to maintain tissue contact time.Other benefits include simplified administration, reduced staff time (fewer drops), improved accuracy and less waste.
