Artificial Tears: A Guide to Selecting the Right Drop for You

Is there anything more overwhelming than the artificial tear aisle at your drug store or pharmacy?  Take 10 minutes and stake it out if you are curious.  You will see poor lost souls wander up and down in frustration, comparing bottle labels that could be written in a foreign language for all they tell you, and then landing on the familiar: Visine.  Oh no!  Everyone, please let me help you break this terrible cycle of doom.

This time of year, allergies are typically subsiding so the most likely reason that your eyes are red, irritated, itchy, burning, or watery is that they are DRY.  Dryness is prevalent in winter due to the lower humidity in the air, and the drying action of heaters in homes, offices, and cars.  In mild cases of dryness, usually a good rewetting drop is all you need to get your eyes performing back to their normal standards.  But for more persistent and chronic dryness, your doctor's intervention with more aggressive treatment is often required.

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If you are in the mild category, you need to pick the right drop in order to get successful relief.  To aid in your selection, please ask yourself these simple questions to see which drop works best for you:

1) Are your eyes infrequently dry, red, watery, itchy, burning or irritated?  Usually after certain environment exposures (like going for a run in the cold air) or at the end of your day?

• Best Choice:  Moisturizing or Lubricating Artificial Tears
• Examples:  Systane Ultra, Refresh Optive, Blink Tears, Soothe XP, Theratears
• Dosage:  1 drop in both eyes as needed, up to 4 x a day

You can also use all of these over top of contact lenses.

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2) Do you have the above issues, but eye drops usually sting when they hit your eye, or cause any other discomfort after using them?   Do you need to use drops more than 4 times a day for relief of your symptoms? Have you recently had a surgical eye procedure (like LASIK) causing you to have more frequent dryness issues?

• Best Choice:  Preservative Free Artificial Tears 
• Why? Prevents irritation from unwanted preservatives that are toxic to the eye but found in all bottle-stored eye drops
• Examples: Systane Ultra in Vials, Refresh Optive Sensitive, Retaine MGD in individual vials
• Dosage:  1 drop in both eyes as needed, can use as often as you want

3) Do you have crusting of your eyelid, or see white dome-like growths on your eyelid margins near the lash roots? Do your eyes sometimes feel filmy between or after blinking?

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• Best Choice: Lipid Based Artificial Tears 
• Why?  The questions above are aimed at diagnosing Meibomian Gland Dysfunction, the most common cause of dry eye.  Click the link to learn more.
• Examples: Refresh Advanced, Systane Balance, Retaine MGD
• Dosage:  1 drop in both eyes as needed, up to 4 x a day (or more with Retaine MGD since it is preservative free)

Not as good over contact lenses due to their thicker lipid base content

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4) Do you have dryness when you wake up in the morning?  Does your roommate, family member, or significant other ever notice you sleep with your eyes open or parted?  Do you sometimes get sharp eye pain when you first wake up?

• Best Choice: Gel Artificial Tears or Ointments
• Why?  Gel tear drops are thicker, and will last through the night to rehydrate the eye or protect the eye if your eyelids do not close fully.
• Examples: GenTeal, Systane Gel, Refresh Gel or Celluvisc, Blink Gel, Nighttime ointments
• Dosage:  1 drop in both eyes at bedtime

These will blur vision (especially the ointments!) so put in when you know you will soon go to sleep.  Do not use over contact lenses unless you want your lenses to be blurry for a while.

Notice what I never mentioned?  That's right, please, please do not buy Visine or Clear Eyes.  They will temporarily relieve some redness, but they will make your dry eye WORSE because they are vasoconstrictors that dry up mucus membranes (which the eye happens to be).  When it comes to artificial tears, you get what you are paying for.  Don't spend your hard earned money on generic products loaded with toxic preservatives if you need to use drops frequently.  The more you pour preservatives on your eyes, the more irritated and dried out your eyes will become.  If you need drops on a regular basis (I would define this as regular, daily use most days of your week) you need high performing drop that is targeted to your underlying dry eye culprit(s).  If you need drops more than a few times a day, you need preservative free tears (and likely more aggressive intervention from your eye care provider!).

Please ask your eye doctor if you want to know why your eyes are dry, and what drop would work best for you.  Your eye doctor is trained to be a dry eye specialist (we all spend a lot of time every day dealing with dry eye!), and can work out a treatment plan that will provide you relief to the best of today's technology.