Risk of Betadine/Povidone Iodine: Does it contain Lye? Yes, but it seems to be safe still for ocular tissues and other delicate mucous membranes.

There is some concern about gargling over the counter Betadine. The concern is that it contains lye which is sodium hydroxide. Sodium hydroxide can be dangerous to the eye if splashed into the eye in high concentrations (ref 1). However, in very low amounts it appears to be very safe for ocular tissues. 

Povidone iodine-containing sodium hydroxide, has been used for years in various preparations as “sterile povidone-iodine eye drops” which are used before most eye surgeries (see photos below which is what many surgeons use as an eye drop before eye surgery and Ref 2). 

Aside from allergy to iodine, these drops seem to be very safe to use before eye surgery. 

Note that the inactive ingredients in both Over the counter Betadine and Minims Povidone Iodine 5% sterile eye drops, solution are the same. 

The key issue is to be sure to dilute 10% povidone iodine to %5 before using on eye or using in nose, gargling, or for other mucous membranes. Avoid inhalation or aspiration. 

More information below:
SLC

Over the counter Betadine:

BETADINE* 5% Sterile Ophthalmic Prep Solution contains 5% povidone-iodine (0.5% available iodine) as a sterile dark brown solution stabilized by glycerin. Inactive Ingredients: purified water, citric acid, glycerin, nonoxynol-9, sodium chloride, sodium hydroxide, and dibasic sodium phosphate.

VERSUS 

Minims Povidone Iodine 5% sterile eye drops, solution

6.1 List of excipients (this means inactive ingredients which are in drops)

– Glycerol

– Nonoxinol 9

– Disodium phosphate anhydrous

– Citric acid monohydrate

– Sodium chloride

– Sodium hydroxide (for pH adjustment)

– Purified water

NaOH
Sodium hydroxide is one of the most common inorganic bases or alkalis. It is also called caustic soda or lye. Formula and structure: The chemical formula of sodium hydroxide is NaOH, and its molar mass is 40.01 g/mol.



Below is the Povidone-Iodine used before every ocular surgery: a couple of drops are applied for a few seconds. It is flushed out after 2 seconds before intra-ocular eye surgery. Sometimes it is left to dry for non-ocular surgeries. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705857/#:~:text=Povidone%2Diodine%201.25%25%20ophthalmic%20solution%20can%2C%20therefore%2C%20be,iodine%20to%20treat%20corneal%20infections.


Minims Povidone Iodine 5% w/v eye drops, solution

Each single dose container provides 20 mg of Iodinated Povidone in 0.4 ml of solution. One milliliter of solution contains 50 mg Iodinated Povidone

Disodium phosphate anhydrous 0.75 mg/ml (0.03 mg in each drop) ( see section 4.8).

https://www.medicines.org.uk/emc/product/3018/smpc#gref

6.1 List of excipients (this means inactive ingredients which are in drops)

– Glycerol

– Nonoxinol 9

– Disodium phosphate anhydrous

– Citric acid monohydrate

– Sodium chloride

– Sodium hydroxide (for pH adjustment)

– Purified water

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