Review (3/5): It smells very very strong - like engine oil
All ointments suffer from poor tube design, it could have a much smaller diameter, so because of this, they all sort of getting 3 or 4 stars. I found other ointments are easier to apply, but liked the tube was totally sealed and it shipped fast. This expires in 3 months and it smells like vaseline used to lube car parts. This may be due to chamomile and marigold plant extracts and wool fat they use, since lanolin or wool from sheep smells like car oil sometimes. I was afraid to use it, company never replied to emails, until 4 months later, after it expired I managed to call them and then had to send an email to some special address. While this may be the best ointment out there for some people, I have no way of knowing that. Just sharing some thoughts on why ointments have their limitations. But it's possible during shipping more reactions happened if hot days and then it could have gotten a stronger smell. I called company and they said the hydramed Sensitive, which has everything in this one except lanolin (sheep wool fat), chamomile and marigold extracts, and they said it does not smell, then it is the combo or one of these 3 that gives it that unpleasant smell.
The good thing perhaps is that it has vitamin A, absent in many other products. So, if you like A, then get Hydramed Sensitive if this bothers you as it bothered me, maybe it was all lanolin and plant extracts causing issues, not the mineral oils... it is, like many or most ointments, hard to administer due to very thick snake coming out of the tube. But I explain below another method one could use to put ointment and see if that helps. VAPal is vitamin A palmitate, the natural form of vitamin A the body uses. “Both VApal (0.05%) eye drops and topical cyclosporine A 0.05% treatments are effective for the treatment of dry eye.” ► Am J Ophthal 2009;147(2):206-213.e3. “VApal improved subjective symptoms, clinical symptoms, and cytological findings in dry eyes” ► Drug Des Dev Ther 2017; 11:1871-9. VApal “and carbomer eye gel can effectively relieve dry eye” ► Glaucoma 2016; 25(6):487-92. So, studies show A works. Whether we need lanolin and chamomile and marigold polyphenols, is unclear, since these are very unstable chemically and could irritate the eye a lot more, since lanolin alone has 10,000-20,000 chemical compounds, lanolin alcohols, and their esters mostly.
One issue with the non-reactive mineral oils, vaseline, paraffin, petrolatum, all of which are mostly saturated alkanes, and which are almost the same, but use different names in EU and USA, etc... is that they got impurities and aromatic hydrocarbons that irritate and redden the eye (all ointments at times, when used even in tiny amounts, way less than what paper instructions say, cause some irritation). Also, their biophysical properties are different: pretty solid at room temp, while healthy meibum is liquid. Due to different electrostatic biophysical properties, versus natural lipids of the tears, they could alter the fine balance of the chemical system of the tears and disturb the homeostasis of the aqueous-lipid layer barrier (plug some outer lipid layer holes, but disturb the inner lipid layer stability where phospholipids face the water; i.e. reality being different from theory sometimes, not having such a universal ‘all good effect’ on 3rd lipid layer stability), or by facilitating certain toxic compounds to more easily cross the junction points between layers of the eye: cornea-vitreous gel, vitreous gel-retina, etc. Additionally, most hydrocarbons believed to be natural to meibum are squalene, which is similar to beta carotene, etc, vastly different than the saturated alkanes in mineral oils. Many authors think the alkanes found in some meibum studies are due to people using face cream, makeup, etc and these entering meibomian glands (or mineral oils in every hand cream and shampoo, in food, etc), where, via different biophysical properties they can slow down certain important regenerative processes, leading to the meibomian gland lipid underproduction or even atrophy in the long-term, while offering short-term protection – just like redness reliever eye drops offer ‘white eyes’ today, but rebound redness 2 years later and damaged blood vessels (by contracting and expanding 1-2 times daily for 3 years) when eyes no longer respond well and we need 5x more of a very acidic drop to prevent redness that destroys the eye since only around pH 7.4-7.6 some eye processes of regeneration are optimal apparently in vitro, not at 5.7-6.3 of redness reliever drops. Thus, not all is rosy just because ‘alkanes don’t chemically react with anything’, they could change electric potentials across membranes, block certain enzymes from folding, proteins, etc, slowing thus important biochemical processes. Being solid vs natural healthy meibum, they are introducing cytokine storm via the ‘foreign body’ sensation they can cause in the first minutes of application, so that’s why when I use these ointments I use a silicone q-tip I disinfect with alcohol afterwards (50 pads for 1$, @ $ store), and apply a tiny bit as explained in eye drop application section, since using 10x more as companies say, while harassing the eyelid daily and making it not fit flush on the eyeball, is risky in my view – it’s too much like something the eye is not used to and causes a little inflammatory cytokine storm that damages the eye and makes people not use the ointment, when it could be safer than Soothe, RetaineMGD, etc drops with many chemicals plus the mineral oils. Always watch for ocular sensations when using any product or write them down so you recall and know when an ointment is bad. “Pharmaceutical grade mineral oil consists of a mixture of saturated hydrocarbons” ► EHJS 2020;22(Suppl J):J34-8. Vaseline (Eur. Ph.) can have 0.67% aromatics, while light liquid or liquid paraffin more like 0.05% ► F1000Res 2017;6:682. It worked better for me many times than the best lipid tears; liquid paraffin can cause lipoid pneumonia if inhaled in large amounts (fire breathing) Occu Med 2010;60(3):234-5, so if via nasal lacrimal duct we inhale tiny levels, what happens? Probably not much to be worried about, since we inhale lipids (though different types of lipids) from our meibomian glands every day, as long as we don’t overdose with ointments. “Aspiration of liquid paraffin (liquid petrolatum) used for the treatment of constipation or intranasal instillation of liquid paraffin as a component of nasal drop or petroleum jelly such as Vaseline or Mentholatum for relief of sinus congestion is the common cause of lipoid pneumonia” ► Intern Med 2002;41(6):483-6. Kids using it for constipation got in trouble too, so it may be better to avoid use for constipation. Even mouth cleaning with edible oils can cause it; however, the amount we would inhale from using it on our eyes (most mineral oil would be ingested actually, as we swallow tears) is way smaller than from oil gargling to ‘clean teeth’; using lipid tears (Systane, Soothe XP, etc got mineral oil (liquid paraffin) too), we can also, in theory, get this issue, since any lipid inhaled can cause it; never heard of anyone using lipid tears getting pneumonia yet, but hey, who knows? Perhaps it’s good to be cautious with these ointment products, use carefully, keep them away from kids and try them first 3 times daytime for 1-2 hours with eyes closed to simulate part of bedtime (or even around the eye only, since many (see amazon reviews) use this as eye cream for the area around eyes, eyelids, since anything around eyelids will affect eyes since it will go inside the eye too, so you can evaluate if it makes eyes red or not; note that if you use them anywhere, they may cause pimple if it blocks pores or 10,000 esters in lanolin cause some issue), before you place them on your eyes for 8-10 hours of sleep, to make sure the 20x mirror doesn’t show anything abnormal and there is no unhealthy sensation or any itching, burning, redness, etc.
Now, let's talk a little about issues with these ointments and tube opening diameter. Ointments are a major headache when it comes to placing into the eye. The manufacturer idea of daily pulling eyelid is not really that great and could damage eyelid, meibum glands, etc. We need alternatives, especially for gels that come out from tube ultra fast even before we even blink. Optical soap is used to wash hands before handling contacts, so basically millions of people stick their hand into eyes indirectly; with an alcohol prep pad (70% isopropyl alcohol, 50/1$ @ $ stores) we can clean and kill 99.9% of bacteria (they sell those 70–75% wipes that say ‘it kills 99.9% bacteria), and even use an opaque box and a UV lamp (some are sold at $ stores even for 4$, the ones amazon sells for 9$) inside to disinfect the silicone q-tip sometimes to reach 99.999%, make it cleaner than contacts touched by fingers, and use it to put 5% of ‘paper instructions amount’ of ointment into the eye via temporal corner. To get some of the snake fast on a silicone sterile q-tip is easy; I do that sometimes even 2-3 times daily to get mineral oil without toxic ingredients in lipid drops with mineral oil (Systane Complete, Retaine MGD, Soothe XP PF, Cationorm, etc). Cap off the tube within 3 seconds, to prevent waste if snake comes out fast, as you want to start with 0.5 mm of ointment first, and put into eyes only 30% of that (I even wrote on my silicone q-tip case “0.5 mm & 30%”), to get eyes more used to it or test allergy and ‘foreign body sensation’, eyelid swelling threshold, etc. The amount of ointment medical companies write to put in eyes is insanely high, about 25-75 times above what you find in a typical eye drop with lipids and even 400 times above natural. This is simply not needed for everyone, they need update tube design to make snake much thinner or use more liquid oils like EvoTears that dispenses 10 μL only, instead of 40 of the typical snake placed inside. Natural tears have 3 layers: mucin 0.035 μm, water 8 μm, lipid 0.1 μm. So, in a natural tear of 10 μL, we get about 80 times more water than lipids, lipids are about 1.2%. When we place 50-75 μL of mineral oil ointment, as paper instructions say, we place 400-600 times more lipids into eyes than natural tears (artificial tears are 30-50 μL, vs 10 max for natural), so it can be overwhelming and even bad, clogging tear drainage, clogging meibum orifices with more solid fats; we can recall that the worst meibomian gland dysfunction patients have solidified oils, so when mineral oils mix with our oils they can clog the glands, offering short-term relief in exchange for long-term meibomian gland damage; like redness relievers provide short term relief in exchange for long-term damage etc. We want in life and medicine quick instant solutions, but the easy path often leads to catastrophe 10-40 years later. While in dire cases of extreme dryness or styes we can use more, but on a daily basis and during daytime, less is better. Present tube design makes using less impossible if you try use Owen guide or traditional eyelid pull method; this results in ocular damage due to too much hydrocarbons damaging homeostasis for those who need much less lipid. Companies could design each product in 2 tube snake diameter versions: one for severe dry eye, present type, and one for mild dry eye, 3-5 times thinner. Once we got 0.5 mm or 1 mm on q-tip, without touching the tube with q-tip, ointment by ultra gently place the gel on the q-tip (avoid finger, even if cleaned with alcohol) at the temporal corner of your eyes, since nasal would drain too quickly and cause too much fuss (or even redness sometimes) due to slightly clogging the drain duct (that’s why punctal plugs often don’t work, since they don’t allow the flushing of that area and it causes inflammation, which makes eye red and dry; so when using ointments and sticky drops be very careful, especially if used at night, as they can cause traffic jam on the ducts and lead to bacteria overgrowth) and that area is very vascularized, more sensitive to ‘foreign object sensation’ stimuli, so nasal corner (or nearby) is best avoided; make sure your finger or q-tip do NOT touch the eyeball or the meibomian gland area, only leave the upper part of the ointment on the edge of the eyelid in a way that minimizes 400 fold the possibility of sterile q-tip or washed disinfected finger bacteria from ever touching any eye tissue, except anything we may touch anyway, or wind could touch with bacteria anyway, like corner of our eye; now obviously, our eyes are used to wind and air we walk thru bringing endless bacteria on the eyeball itself, but we don’t want to bring extra if we can help it, to prevent infection. Use left fingers or designated (for this purpose alone, not using it to touch any eye area) silicone q-tip for spreading antifog gels on glasses and right hand for placing ointments to avoid cross contamination of your eyes with antifog gel in case you didn’t wash properly your finger tips that handle the q-tip or ointment. Avoid cotton tips at all costs for this, since fibers get into eye and make it red; make sure hair near eyes is short so it doesn't cause red eyes by getting into eyes; wash with optical soap and then perhaps 70% alcohol wipe if reusable silicone made. This way you don’t pull on eyelid and risk touching eyeball with the tube as in the traditional ‘eye drop and gel placing’ videos; before you do this, you may consider washing hand & q-tip with OPTICAL SOAP that leaves up to 22 times less residue on hands than regular soap; made for contact lens handling: $15/L Leader optical soap, by Hilco (USA, since 1956), can be used to wash tips of fingers before touching ocular area or applying ointments. MSDSs for antifog and soap, etc Hilco products are on their site. Simply place the ointment on silicone sterile q-tip without touching the tube, by pulling the q-tip (avoid using finger ideally) away from the tube as it grabs on the snake of ointment; make sure that you get enough snake there so when you go near eye only the top of the gel ball gets into the eye ideally to avoid touching eyelid with the silicone; I find this 90x easier than using Owen for ointments, while Owen is ideal for drops; Owen causes the snake to touch the eye guide and to get stuck on eyelash as we blink; Owen use on tubes leads to wasting most tube really fast; they need design ointment tubes with much thinner snakes, but that won’t happen overnight, so we cannot use Owen easily for ointments without wasting 70%-95% of the tube until they do rethink the snake thickness in all major brands to be 3-5 times thinner. Clean fingers you use to clean silicone q-tip, hands you use to handle tube. Do this in a bright area, while sitting so you can be very stable, not move head and avoid touching eyeball with too much gel from the q-tip.