Top Eye Drops for Dry Eyes

As an optometrist, I often encounter several frequently asked questions regarding eye irritation:

1. What could be the reason behind the discomfort and irritation in my eyes?
2. Can any eye drops effectively eliminate redness in my eyes?
3. How can I quickly relieve bloodshot eyes?

If these questions resonate with you, it's important to note that dry eye is a common culprit behind these symptoms. However, for an accurate diagnosis, it is advisable to schedule an appointment with your optometrist.

Before we start, definitely try to avoid using any "red eye relief" or "redness relief" eye drops, such as Visine and Clear Eyes, as they do not effectively address the issue at hand.

Allow us to introduce eye lubricants! They serve as the primary approach to managing dry eyes, aiming to lubricate the eyes, replenish moisture, and supplement your natural tears.

Preservative or Preservative-Free?

• Preservatives allow eye drops to be stored for up to three months after opening. However, they are known to cause adverse effects on the surface of the eye. Lubricants with preservatives can be used up to four times a day.
• Benzalkonium chloride (BAK), one of the most common preservatives in artificial tears and lubricants, is linked to corneal membrane instability resulting from the interactions of lipid components in the cell membrane.
• It has also been reported that preservative eye drops increase ocular symptoms (burning and itchy eyelids), as well as ocular signs (superficial punctate keratitis and conjunctival hyperemia). 
• Preservative Free should be recommended for patients with ocular allergies and those who need to use eye drops more than four times a day. They are individually packaged in small vials.

Selecting a preservative-free lubricant for the eyes can diminish the potential adverse effects on the eyes and has demonstrated improvement in the signs and symptoms of the patient's dry eye disease.

However, in cases where a preservative-containing eye drop is necessary, alternative preservatives such as Polyquad, polyhexamethylene biguanide (PHMB), and oxidized complexes have been found to cause less disruption to the ocular surface.

Phosphate Free Lubricants? 

Some eye lubricants contain phosphate and can be harmful for the eye only in certain cases. 

Phosphate is a mineral that is naturally found in the body. However, when it is used in eye drops, it can bind to calcium in the tears and form calcium phosphate crystals. These crystals can deposit on the cornea, the clear front part of the eye. This can lead to corneal calcification, which can cause blurred vision, pain, and sensitivity to light.

The risk of corneal calcification is highest in people who have corneal epithelial defects or pronounced corneal damage, such as corneal erosions or ulcers. These defects allow calcium to leach into the cornea, which makes it more likely that phosphate will bind to it and form crystals

Artificial Tears / Eye Lubricants

These are commonly recommended as the initial choice for treating dry eyes due to their easy application and minimal residual blur. It is suggested to use them up to six times a day. However, if the frequency exceeds four times a day, it might be advisable to switch to a more viscous option, such as a gel or ointment.

💡 Administer 1 drop in each eye up to 4 times daily.

Pros	Cons
Less stickiness feeling	Only keeps the eye lubricated for a short period of time
Less visual blur after instilling eye drop
Can be used throughout the day
Many preservative-free options

Depending on the type of dry eyes you suffer from, you may need to supplement the moisture, oil or both to achieve relief! All our recommendations are preservative-free and compatible while wearing contact lenses.

💧Supplement moisture

They provide lubrication and viscosity to the tears and can be important for those with aqueous deficient dry eyes.

• HyloForte and HyloFresh (PBS)
  • Hyloforte - Sodium Hyaluronate 2 mg/mL
  • Hylofresh - Sodium Hyaluronate 1 mg/mL
  • Can be used for 6 months after opening
  • 10ml bottle – 300 drops
  • Phosphate-free
• Systane Ultra and Systane Ultra UD
  • Fast relief from dry eye symptoms caused by environmental factors such as screen time, air quality and/or seasonal issues
• Systane Hydration UD
  • Typically used in contact-lens related dry eye or surgically-induced dry eye
  • Contains Sodium Hyaluronate
• Refresh
• Bion Tears
• Blink Intensive Tears Vials
  • Contains Hyaluronic acid

A meta-analysis published in 2021 showed a superiority of hyaluronic acid containing artificial tears compared to non-hyaluronic acid eye drops.

🧴Supplement oil

Helps to supplement abnormal lipid production, as they closely mimic the oil layer of the tear film that is secreted from the meibomian glands. This can be important for those with evaporative dry eye/MGD.

• NovaTears (PBS) and NovaTears + Omega-3
  • Can be used for 6 months after opening
  • Phosphate-free
• Cationorm (PBS)
  • Preservative-free
  • Compatible with all contact lenses
  • Cationorm Multi Dose (10mL) is on PBS
  • Cationorm 30 x 0.4mL vials are not on PBS

💡 Our favourite dry eye lubricating cocktail is using a drop of HyloForte and then adding another drop of NovaTears! 

Eye Gels

Eye gel formulations are the preferred option when liquid eye lubricants prove insufficient or are administered more than four times a day. They prove beneficial for patients experiencing moderate to severe dry eye or lagophthalmos, effectively covering the exposed part of the eye during sleep.

Pros	Cons
Can be used during the daytime or at night time	Most eye gels on the market have preservatives
More viscosity means that it will last longer on the cornea	Many people do not like the consistency of gel drops as they blur the vision slightly
Doesn't need to be instilled as often

 All our recommendations are preservative-free.

• Celluvisc Gel (PBS)
  • Single use vials
• Poly Gel (PBS)
  • Single use vials
• Viscotears Gel UD (PBS)
  • Single use vials

Ointments

If you've already experimented with liquid lubricants, preservative-free lubricants, and eye gels without finding relief from dry eyes, it is advisable to consider transitioning to an ointment. Typically, ointments are reserved for individuals with moderate to severe dry eyes.

Ointments can also be beneficial for lagophthalmos patients, offering protection for their eyes during sleep.

Pros	Cons
Stays on the cornea for a lot longer	Causes blurry vision for a long period of time
Only used once at night time before sleep due to it's thicker formulation	Causes eyelids to stick together
Easier to know when you've applied it as you physically see the ointment being applied. Giving you reassurance that it went into the eye	Need to clean eyelids/eyelashes in the morning

 All our recommendations are preservative-free.

• Vita-Pos Ointment (PBS)
  • Contains retinol palmitate
  • Use period of 6-months after first opening
• Poly Visc Ointment (PBS)
  • Contains paraffin
  • Use period of 1-months after first opening

💡 Ointments are best used before bedtime

Manuka Honey

They have both antibacterial and anti-inflammatory properties that help with both aqueous deficient and evaporative dry eye. 

• Optimel Manuka Dry Eye Drops
  • Contains 16.5% manuka honey
  • Contains preservatives - Benzoic Acid
  • It is also believed that the hyperosmolarity of Optimel helps to draw oils out of the glands
  • Lower tear film pH and reduce bacterial overgrowth and inflammation, stabilising the ocular surface
• Optimel Manuka Forte Eye Gel
  • Contains 98% manuka honey
  • Shelf-life - Indefinite / Preservative free 

Do not use if there is a history of hypersensitivity or sensitive to honey, food gums or benzoate preservatives (only applicable to the eye drops formulation).

💡 Use twice daily

Miebo

MIEBO (Bausch + Lomb) is a ground breaking dry eye drop, recently FDA-approved in May 2023 as a pioneering treatment for addressing the signs and symptoms of dry eye disease, primarily linked to meibomian gland dysfunction. This innovative solution focuses on combating tear film evaporation.

In the phase 3 studies, conducted over 8 weeks, MIEBO demonstrated a significant improvement in both corneal staining and the eye dryness visual analogue scale, providing relief from dry eye symptoms as early as 15 days.

Formulated with 100% perfluorohexyloctane, MIEBO contributes to stabilizing the tear film by engaging with the lipophilic tear layer, creating a film-air interface that effectively prevents evaporation.

This non-aqueous liquid composition not only ensures the prevention of bacterial growth but also eliminates the need for preservatives. MIEBO is available exclusively through prescription only by optometrists. 

Beware of Recalled Eye Drops! 

Be cautious when using eye drops that have been recalled. Periodically review this list to ensure that you are informed about the latest recalls. Stay updated with the Recalled Eye Drops List!

Beware of Homeopathic Eye Drops!

Certain over-the-counter (OTC) artificial tears and lubricants are marketed as homeopathic. Individuals may be enticed to purchase these homeopathic artificial tears, believing they are a "healthier" and chemical-free choice for eye care.

Typically, these homeopathic eye drops incorporate plant-based ingredients such as euphrasia and calendula. It's important to emphasize that the ingredients in these eye drops lack scientific support and may potentially harm the eyes instead of providing benefits.

If you encounter someone using homeopathic dry eye drops, kindly advise them to discontinue use immediately. Take the opportunity to educate them on the importance of relying exclusively on scientifically researched and proven artificial tears for optimal eye care.

Frequently Asked Questions! 

Can you use contact lens solution as eye drops?

Contact lens solutions are specifically formulated for cleaning, disinfecting, and storing contact lenses. They are not intended to be used as eye drops. While some contact lens solutions may contain ingredients that are similar to those found in artificial tears or eye drops, they can also contain other components that might not be suitable for direct application to the eyes.

Using contact lens solution as eye drops can potentially cause discomfort, irritation, and even more serious issues such as corneal damage. If you're experiencing dry or irritated eyes, it's best to use lubricating eye drops that are specifically designed for soothing and moisturising the eyes.

Do eye drops expire?

Yes, eye drops do expire. The expiration date is usually printed on the label of the bottle. Unopened eye drops usually expire 1-2 years after the manufacturing date. Once you open a bottle of eye drops, you should use it within 30 days. This is because the preservatives in the eye drops start to break down after they are opened, which can lead to contamination - unless stated otherwise! 

Can you use eye drops with contacts?

Yes, you can use eye drops with contact lenses, but not all eye drops are safe to use with contacts. It is important to check the label of the eye drops to see if they are safe to use with contacts or check out the list above to see options that are suitable for contact lenses.