BSS PLUS
Clinical safety rating: caution
Comprehensive clinical and safety monograph for BSS PLUS (BSS PLUS).
BSS PLUS (Balanced Salt Solution Plus) is an intraocular irrigating solution containing glutathione, bicarbonate, and glucose. It maintains corneal endothelial cell integrity and function during intraocular surgery by providing a physiological ionic composition (sodium, potassium, calcium, magnesium, chloride, phosphate) and metabolic substrates (dextrose, glutathione). Glutathione acts as a reducing agent to protect against oxidative stress.
| Metabolism | Glucose is metabolized via glycolysis and oxidative phosphorylation. Glutathione undergoes oxidation-reduction recycling via glutathione peroxidase and reductase. Bicarbonate participates in pH buffering. Not systemically absorbed in significant amounts. |
| Excretion | Renal elimination of electrolytes and components (e.g., sodium, potassium, chloride, calcium, magnesium) follows their respective physiological clearance. No active drug excretion as BSS PLUS is a balanced salt solution. |
| Half-life | Not applicable; components are endogenous electrolytes with rapid renal clearance. Clinical context: constant infusion maintains steady-state concentrations without accumulation. |
| Protein binding | Negligible (<5%) for electrolytes; binding proteins: albumin (minor for calcium, magnesium, chloride). Sodium, potassium, chloride are unbound. |
| Volume of Distribution | 0.2 L/kg (approximate for total body water); clinical meaning: distributes into extracellular fluid; no tissue binding. |
| Bioavailability | Not applicable for intraocular irrigation; systemic absorption negligible if used as directed. No oral bioavailability – not administered systemically. |
| Onset of Action | Immediate upon intraocular irrigation; maintains corneal endothelial cell function and ocular tissue hydration. |
| Duration of Action | Duration matches irrigation period; after discontinuation, electrolyte balance returns to preoperative levels within minutes due to endogenous regulation. |
Intraocular irrigation during surgery: 500 mL bottle, use as needed to maintain intraocular volume and pressure. No systemic dose.
| Dosage form | SOLUTION |
| Renal impairment | No systemic absorption; renal adjustment not applicable. |
| Liver impairment | No systemic absorption; hepatic adjustment not applicable. |
| Pediatric use | Same as adult: intraocular irrigation as needed during surgery. No weight-based dose. |
| Geriatric use | No specific considerations; use as for adults. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for BSS PLUS (BSS PLUS).
| Breastfeeding | BSS PLUS is not systemically absorbed; therefore, it is unlikely to be excreted into breast milk. M/P ratio is not applicable. Considered compatible with breastfeeding due to negligible systemic exposure. |
| Teratogenic Risk | BSS PLUS is an intraocular irrigating solution containing electrolytes, bicarbonate, dextrose, and glutathione. As it is used locally during ophthalmic surgery and not systemically absorbed in significant amounts, it poses minimal teratogenic risk. No specific fetal risks have been identified across trimesters; however, as with any medication during pregnancy, use only if clearly needed. |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to any component. Do not use for intravenous administration. Not for injection other than intraocular irrigation.
| Precautions | Do not use if solution is discolored, cloudy, or contains precipitate. Contains calcium; avoid mixing with solutions containing phosphate unless properly formulated. Use only via sterile irrigation. Prolonged exposure of retina to BSS PLUS may cause retinal toxicity (avoid use in conditions with compromised blood-retinal barrier). Monitor intraocular pressure during use. |
| Food/Dietary | No known food interactions. |
| Clinical Pearls |
Loading safety data…
| Fetal Monitoring | No specific maternal or fetal monitoring is required beyond standard ophthalmic surgical procedures. Monitor for potential allergic reactions or intraoperative complications. |
| Fertility Effects | No known adverse effects on fertility in males or females due to localized use and lack of systemic absorption. |
| BSS PLUS is a sterile intraocular irrigating solution used during ophthalmic surgery to maintain corneal clarity and protect intraocular tissues. Contains glutathione, glucose, and bicarbonate buffer. Avoid use in patients with hypersensitivity to any component. Must be used immediately after opening; discard unused portion. |
| Patient Advice | This solution is used during eye surgery to maintain the health of the eye. · You may experience temporary blurred vision or discomfort after surgery. · Follow all post-operative care instructions provided by your surgeon. · Report any signs of infection such as increasing pain, redness, or discharge. · Do not rub or touch the operated eye. |