If you’re one of the 100 million Americans who shop online or at the drug store for artificial tears or eye lubricating drops, you now have more options than ever before. If you’re not quite sure how to choose, read on.
Dry eye and ocular surface disease specialist Christopher Starr, MD, an Academy member and ophthalmologist, demystifies the categories of eye drops and explains how to choose the best one for your needs.
First, visit an ophthalmologist
“If you’re experiencing dryness or irritation in your eyes and relying on over-the-counter lubricants more than two or three times per day, it’s important to see an ophthalmologist and have a comprehensive examination,” said Dr. Starr. “Lubricants can provide brief symptom relief for almost every type of ocular surface disease, but you still need to be treated for the underlying condition causing those symptoms.”
Your doctor will help pinpoint the sub-type(s) of dry eye disease (DED) and ocular surface disease (OSD) you have, prescribe disease-modifying therapies and tailor recommendations to your precise needs, including the right types of lubricating medicine(s).
Know what type of dry eye disease you have
There are two main forms of dry eye disease: evaporative dry eye and aqueous-deficient dry eye.
- Evaporative dry eye occurs when you have a deficiency in the oily layer of your tear film, causing your tears to evaporate quickly. Most people have this type of dry eye disease. Aqueous deficient dry eye occurs when your body doesn’t produce enough tears, and is often caused by an auto-immune disease like Sjogrens Syndrome.
For evaporative dry eye, Dr. Starr typically recommends lubricants with lipid- or oil-based ingredients, which can help thicken the tear film and reduce excessive evaporation. Look for a drop that lists any type of “oil” in the ingredients and/or mentions “evaporative dry eye” specifically.
- For aqueous-deficient dry eye, look for lubricating drops with these key words on the packaging: “hypotonic” or “hypoosmolar”. These drops are typically thinner and lighter than oil-based drops, and will increase the volume of your tears and re-wet your ocular surface.
But don’t worry if you’re using the opposite one. “There’s not really a ‘wrong’ choice since many cases of dry eye disease are mixed or have hybrid causes,” said Dr. Starr. “Over-the-counter lubricants will almost always feel good so feel free to experiment with different types of drops to see what works best for you."
Steer clear of “red eye relief” and unapproved eye drops
There’s one type of drop patients should avoid experimenting with, however.
Be careful of eye drops that are marketed to relieve red eyes, as they often contain vasoconstrictors which can actually worsen symptoms and redness over time. Ingredients to stay away from include tetrahydrozoline and naphazoline.
Brimonidine-containing drops are sometimes safer and more effective, said Dr. Starr. But long-term effects of brimonidine drops are not clear. It’s important to see an ophthalmologist to determine the cause of a red eye rather than self-treating.
Additionally, in light of several significant recalls, avoid all drops that are listed on the FDA’s recall lists.
When to use preservative-free eye drops
Lubricants with preservatives have a longer shelf life and generally cost less than those without preservatives. Preservative-free lubricants have sophisticated technology built into the tip of the bottle that filters out bacteria, lowering your risk of eye infection.
If you’re using lubricants only occasionally (i.e., a few drops per week) then a preserved drop is likely safe, said Dr. Starr. But if you’re lubricating more than four times a day over a long period of time then be sure to reach for a preservative-free drop.
Choosing between single- and multi-dose drops
Preservative-free lubricants are available in larger, multi-dose containers or in multiple, smaller single-dose bottles which claim to lower the risk of bottle contamination and eye infection even further.
However, “there’s no reason to fear multi-dose packaging as long as the company is reputable and uses the latest technology,” said Dr. Starr.
Considerations to weigh are cost, convenience and environmental impact. Single-dose treatments are typically more expensive while multi-dose bottles cut down on plastic and environmental waste.
Choosing between eye drops or gels or ointments
Gel-based drops are thicker than liquid lubricating drops. Ointments are the thickest, most concentrated lubricant type and are dispensed from tubes rather than bottles.
“The thicker the lubricant is the longer it tends to last on the ocular surface,” said Dr. Starr. “But thicker also generally means more or longer-lasting blurriness after placement in the eye,” he explained.
For that reason, Dr. Starr often recommends liquid drops for daytime use and gels and/or ointments at night. “Stick with liquid lubricants if you’re working, reading, watching TV, driving or doing anything that requires high level vision,” he said. “But if you’re relaxing after hours or on weekends, gel drops can provide longer-lasting relief,” he said.
If your eyelids don’t close completely (lagophthalmos) or you have severe floppy eyelid syndrome or experience eye discomfort when sleeping, Dr. Starr recommends ointment at night. “Make it the last thing you do before going to sleep,” he advised. “Pull your lower lid down, squirt about ¼ inch of ointment into the opening and close your eyes to let it distribute across the ocular surface,” he said.
Can you use eye drops with contact lenses?
Stick to preservative-free lubricants and make sure you choose one that clearly states “safe/designed for contact lens wear” on the packaging if you are placing drops while wearing your lenses.
For all other drops be sure to take out your contact lenses first, wait five minutes, instill the lubricating drops, and then wait another 10-15 minutes before putting lenses back in. If you put a drop that is not formulated for contact lens wear directly on top of your lens, your eye may become irritated. If this happens consider throwing out the lenses and using new ones, Dr. Starr suggested.
Using eye drops during recovery from eye surgery
People tend to have worsening symptoms of dryness or irritation after having LASIK, cataract or other ocular surgeries, said Dr. Starr. You should choose a preservative-free drop to lower your risk of toxicity and consider leaning toward liquid drops which are less likely to blur your vision as you recover.
Call your ophthalmologist if you notice any sign of eye infection
Call your eye doctor right away if your eyes are very red, painful, watery or sensitive to light. Do the same if you have blurry vision or notice discharge (ooze or pus) coming from your eye. These can be symptoms of serious eye problems.
The bottom line
No single brand of eye drop works best for every person. You may need to try several different types before you find one—or a combination—that works best for you.