N-acetylcysteine (NAC) was first discovered as a mucolytic agent in 1960. We investigate the role of topical NAC in ocular therapeutics, including its mechanism of action, current applications, and adverse effects. A systematic search of peer-reviewed articles identified 106 references including in vitro, in vivo and clinical studies on the use of NAC in the treatment of ocular diseases. NAC can be synthetically manufactured, and its mechanisms of action include mucolysis, scavenging hydroxyl radicals, and modulation of inflammatory cascades. These unique properties contribute to the diverse applications of NAC, including its steroid-sparing potential. NAC has been used topically in the treatment of corneal wounds, chemical injuries, keratitis, dry eye disease and meibomian gland dysfunction. The clinical benefits of NAC are evident over a wide range of concentrations, the most common being 5-10% topical NAC applied four times daily. Adverse effects such as corneal necrosis are rare, but have been reported with higher doses. NAC also has potential applications in laser epithelial keratomileusis, diabetic eye disease, retinitis pigmentosa, senile nuclear cataracts, macular degeneration, and cigarette smoke-induced corneal damage. Recently, chitosan-NAC has been used as a nanocarrier for the topical administration of medications to the ocular surface. Owing to its potent antioxidant, anti-inflammatory and mucolytic properties, topical NAC has had extensive use in the treatment of ocular pathology.

N-乙酰半胱氨酸 (NAC) 于 1960 年首次作为粘液溶解剂被发现。我们研究了局部 NAC 在眼部治疗中的作用，包括其作用机制、当前应用和不良反应。对同行评审文章的系统搜索确定了 106 篇参考文献，包括体外、体内NAC在眼部疾病治疗中的应用和临床研究。NAC 可以合成制造，其作用机制包括粘液溶解、清除羟基自由基和调节炎症级联反应。这些独特的特性有助于 NAC 的多种应用，包括其节省类固醇的潜力。NAC 已局部用于治疗角膜伤口、化学损伤、角膜炎、干眼病和睑板腺功能障碍。NAC 的临床益处在广泛的浓度范围内都很明显，最常见的是每天四次使用 5-10% 的局部 NAC。角膜坏死等不良反应很少见，但据报道使用较高剂量。NAC 在激光上皮角膜磨镶术、糖尿病眼病、视网膜色素变性、老年性核性白内障、黄斑变性和香烟烟雾引起的角膜损伤。最近，壳聚糖-NAC已被用作纳米载体，用于将药物局部给药至眼表。由于其有效的抗氧化、抗炎和粘液溶解特性，外用 NAC 在治疗眼部病变方面具有广泛的用途。