Limited Use Note(s)
DEXTRAN 70 & HYDROXYPROPYL METHYLCELLULOSE & POLYQUAD
0.1%/0.3%/0.001% Oph-Sol
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Reason For Use Code
Clinical Criteria
49
For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy.
LU Authorization Period: Indefinite
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