Liposomal Ozonated Oil in the Treatment of Eye Infections

Introduction

For eye infections and traumas, various treatments are usually used to prevent infections and promote re-epithelialization. However, the excessive use of antibiotics has led to the development of multi-resistant bacterial strains, creating a need for new antimicrobial drugs with different mechanisms of action. Liposomal ozonated oil is the first ozone-based ocular antiseptic for the prevention and treatment of eye infections. 

The authors of the cited work conducted a literature survey in the PubMed, Medline, Web of Science, and Cochrane Library databases, searching for studies published up to June 2021. Based on keywords, they identified papers on the use of ozonated oil for eye infections. They selected 25 of these and compiled a review on the composition, mechanism of action, regenerative properties, efficacy, and safety of ozonated oil preparations based on the results of preclinical and clinical studies focusing on eye infections.

Composition and Mechanism of Action

Liposomal ozonated oil is produced through a chemical reaction involving gaseous ozone, forming ozonides after binding to fatty acids. Since ozonated sunflower oil irritates the cornea, it is encapsulated in a layer of liposomes made from soybean phospholipids. After application, the liposomes bind to the pathogen's surface and release ozonides, which penetrate the microorganism, generating lipid peroxides and reactive oxygen species upon hydrolysis. These disrupt membrane proteins, lipids, enzymes, and the DNA/RNA of the pathogen, leading to its destruction. They act on bacteria, viruses, and fungal microorganisms. Ozone is a molecule naturally present in the immune system, and besides destroying pathogens, it also has a signaling function, enhancing the immune response by increasing the levels of nuclear factor kappa B (NF-κB), tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL-6).

Preclinical Studies

Antimicrobial and regenerative effects of liposomal ozonated oil have been demonstrated in 6 preclinical and 5 clinical studies. Preclinical studies have documented its antiseptic and regenerative effects on corneal and conjunctival tissue. In therapeutic doses, it showed no toxicity to epithelial cells in an in vitro study with human corneal epithelium. After 3 days, it led to cell proliferation compared to controls. Absence of toxic effects was also demonstrated in in vivo studies.

Clinical Studies

In patients with complicated corneal diseases, liposomal ozonated oil helped heal corneal ulcers and reduce keratitis within 10 days. In patients with inflammatory and infectious eye diseases, it reduced and nearly eliminated symptoms of vernal, granulomatous, and even adenoviral conjunctivitis. It also proved effective in reducing ocular microflora in preoperative prophylaxis.

Application of liposomal ozonated oil led to similar or better results than conventional antiseptics and antibiotics. Liposomal ozonated oil demonstrated a broad antimicrobial spectrum and a low incidence of adverse events. It was well-tolerated on the cornea and conjunctiva, and clinical studies confirmed its good safety profile and biocompatibility on the ocular surface.

Conclusion

Liposomal ozonated oil has antiseptic and regenerative effects on corneal and conjunctival tissue. It has shown efficacy and a good safety profile in eye infections and can be considered a suitable supportive strategy in the treatment of these conditions, either alone or in combination with other antimicrobial agents.

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Source: Pérez-Santonja J. J., Güell J. L., Gris O. et al. Liposomal ozonated oil in ocular infections: a review of preclinical and clinical studies, focusing on its antiseptic and regenerative properties. Clin Ophthalmol 2022 Jun 14; 16: 1953−1962, doi: 10.2147/OPTH.S360929.