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Benzalkonium chloride (BAK) is the most frequently used preservative in preserved eye drops. BAK can induce corneal and conjunctival epithelial cell apoptosis, damage corneal nerves, delay wound healing, interfere with tear film stability and cause loss of goblet cells.³
The negative symptoms experienced through the use of BAK-preserved drops may impact adherence to the prescribed treatment or management regime.⁴
Preservative-free tear replacement is preferred in cases of frequent and chronic application.⁵
Patients with Dry Eye Disease (DED), especially those with severe DED who require dosing over 4 times daily with lubricants or who use ocular lubricants in conjunction with other chronic topical therapies such as glaucoma medications, should avoid the use of ocular lubricants containing preservative.³

Product	HYLO Tear	HYLO Forte	Evolve HA	Hyabak	Thealoz Duo
Drug Tariff price¹	£8.50	£9.50	£5.99	£8.99	£7.99
Average duration of scripts (days)	30.31	30.65	19.78	27.07	25.55
Annual cost to ICS per patient	£102.36	£111.85	£110.53	£128.43	£107.73

*Analysed data for preservative free (PF) ocular lubricants from Cegedim’s THIN database, Jan 2020-Dec 2020 (Representative of 400+ GP practices & 3.2M patient population)

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