When BSS Ophthalmic Solution Isn't Available, You Have Options

If your ophthalmologist or surgical center is having trouble finding BSS Ophthalmic Solution, you're not alone. Supply constraints have made this essential surgical irrigating solution harder to locate in recent years. But here's the good news: there are several legitimate alternatives that your surgeon can consider.

This guide covers what BSS is, how it works, and the most common alternatives that eye surgeons use when standard BSS isn't available.

What Is BSS Ophthalmic Solution?

BSS stands for Balanced Salt Solution. It's a sterile, isotonic irrigating solution manufactured primarily by Alcon Laboratories. Eye surgeons use it during procedures like cataract surgery, vitrectomy, corneal transplants, and other ophthalmic operations to keep the eye moist and maintain the natural environment of the eye's interior.

Each milliliter of BSS contains a carefully balanced mix of salts — sodium chloride, potassium chloride, calcium chloride, magnesium chloride, sodium acetate, and sodium citrate — dissolved in water for injection. The solution has a pH of approximately 7.5 and an osmolality of about 300 mOsm/kg, designed to match the eye's natural aqueous humor.

For a complete overview, read: What Is BSS Ophthalmic Solution? Uses, Dosage, and What You Need to Know.

How Does BSS Work?

During eye surgery, the surgeon needs to irrigate (rinse) the inside and outside of the eye to maintain visibility, flush away debris, and protect delicate eye tissues. The irrigating solution must closely match the natural composition of the fluid inside your eye. If the solution is too acidic, too alkaline, or has the wrong salt concentration, it can damage the corneal endothelium — the delicate layer of cells on the back of the cornea that keeps your vision clear.

BSS provides a physiologically appropriate environment that minimizes damage to these sensitive tissues during surgical manipulation. For a deeper dive into the science, see: How Does BSS Ophthalmic Solution Work? Mechanism of Action Explained.

Alternative #1: BSS Plus (Alcon)

BSS Plus is the enhanced version of standard BSS, also made by Alcon. It contains everything in regular BSS, plus three additional ingredients:

• Bicarbonate — helps maintain stable pH during longer procedures
• Dextrose — provides energy to eye cells during surgery
• Glutathione — an antioxidant that helps protect the corneal endothelium

BSS Plus is FDA-approved for intraocular irrigation during all ophthalmic surgical procedures, including those lasting longer than 60 minutes. It's generally considered superior to standard BSS for protecting corneal endothelial cells, especially during extended surgeries.

Cost: Approximately $107 for a 500 mL container, compared to $21-$42 for a 15 mL vial of standard BSS.

Best for: Any intraocular surgery, particularly longer procedures like complex cataract cases, vitrectomy, or corneal transplants.

Alternative #2: Navstel

Navstel is a balanced salt ophthalmic solution that includes hypromellose, dextrose, and glutathione. Like BSS Plus, it offers enhanced protection for intraocular tissues compared to standard BSS.

Navstel is FDA-approved for use as an intraocular irrigating solution during ophthalmic surgery. It provides similar benefits to BSS Plus, with the addition of hypromellose, which helps coat and protect the corneal surface.

Best for: Surgeons looking for an alternative to Alcon products with enhanced corneal protection.

Alternative #3: Endosol Extra

Endosol Extra is another intraocular irrigating solution that serves as an alternative to BSS. It's designed to maintain the physiological environment of the eye during surgical procedures.

Best for: Surgical centers that need a non-Alcon option for intraocular irrigation.

Alternative #4: Lactated Ringer's Solution (Off-Label)

Important note: Lactated Ringer's Solution is not FDA-approved for intraocular use. However, in resource-limited settings or emergencies, some surgeons have used it as a last-resort irrigating solution. It lacks the precise electrolyte balance of BSS and does not contain calcium or magnesium in the ratios needed for optimal corneal protection.

This should only be considered when no FDA-approved ophthalmic irrigating solution is available, and only under the direct judgment of an experienced ophthalmologist.

How to Choose the Right Alternative

The decision of which alternative to use is ultimately your surgeon's call. Factors they'll consider include:

• Length of the procedure — BSS is suitable for procedures under 60 minutes; BSS Plus or Navstel may be better for longer surgeries
• Type of surgery — More delicate procedures may benefit from enhanced solutions with glutathione
• Availability — Your surgeon will work with what's in stock at their surgical center
• Cost — BSS Plus is more expensive than standard BSS, which may factor into facility decisions

For help locating any of these products, visit Medfinder to check real-time availability.

Final Thoughts

While BSS Ophthalmic Solution shortages can be stressful — especially when you have surgery on the calendar — the availability of alternatives like BSS Plus, Navstel, and Endosol Extra means that your procedure can usually still move forward safely. The key is open communication with your surgical team.

Ask your ophthalmologist which irrigating solution they plan to use and whether supply is secure. If you want to be proactive about finding BSS or its alternatives, Medfinder can help you check stock in your area.

For more on the current supply situation, read: BSS Ophthalmic Solution Shortage Update: What Patients Need to Know in 2026.