The Patient's Guide to Artificial Tears

7:52 PM

Need a rewetting drop?  Try browsing the eye drop aisle at your local pharmacy and you will immediately find yourself overwhelmed with the number of products available.  Dry Eye Syndrome is one of the most common ocular problems of our generation.  Between endless marathons of computer use and the dryness associated with so many common systemic medications for allergies, high blood pressure, and anxiety or depression, dryness is a way of life for many Americans.  Only your doctor can tell you what kind of Dry Eye you suffer from (yes, there are different types!).  Here's a break down of the best over the counter tears for the underlying causes of your dryness.

Aqueous deficiency is the "classic" dryness we talk about with  dry eye.  These patients usually have dryness as a result of hormonal changes, systemic medication side effects, contact lens wear, or extended computer use.  My favorite drops for these patients (which can also be used over contact lenses) are:

Systane Ultra

Refresh Optive

Blink Tears


Clogged meibomian oil glands are a very common cause of dryness!  Photo via Review of Optometry
Meibomian Gland Dysfunction (click here for more information) is a condition where dryness is caused by clogged or impacted oil glands of the eyelids.  These meibomian glands secrete an important lipid-based layer of the tear film that coats and prevents evaporation of your tear film between blinks.  The artificial tears that work best in this case (theoretically) are a new technology of lipid based tears.  The idea is to replace the component of the tear film that the eye is missing.  Using these tears in conjunction with warm compresses and eyelid hygeine can greatly improve comfort.  Your two choices on the market are:

Systane Balance

Refresh Advanced

Note: These tears are very new to the market and we are just learning about their effectiveness.  They are slightly more "milky" in appearance, so don't be alarmed when you purchase these tears by their color.  

Ectropion is very common as the eyelids naturally begin to
loose elasticity and sag.
Exposure occurs when the cornea becomes too dry due to prolonged lengths of time without tear film coverage.  Older patients whose eyelids are too lax to sit against the eye (a condition called ectropion) chronically suffer from exposure.  This can also happen after blepharoplasty (eyelid lifts or brow lifts) or botox injections because your eye may not shut all the way between blinks.  Another possible cause of exposure is lagophthalmos, a relatively common condition where the eyelids slowly creep apart as a person sleeps, exposing the cornea overnight.  If you wake up with dry eyes, you probably have lagophthalmos.  I prefer to treat this type of dryness with thicker, longer lasting gel tears such as:

Systane Gel

Refresh Celluvisc

Blink Gel

Note:  Gel tears are very thick, so expect them to cause minor blur to your vision that should clear within a minute or two.  Due to their thickness, I do not recommend using gel tears while wearing contact lenses.  They work great overnight, but I have a lot of patients that like them during the day due to their prolonged contact time with the eye.  Typically gel tears provide longer lasting relief.

Remember, sometimes you can have several components contributing to your dryness, so your doctor may recommend several types of tears.  I sometimes use an aqueous tear during the day, and a gel tear before bed time for my more symptomatic dry eye patients.  Another important point to remember: if you are using a preserved tear (anything in a bottle!), then do not use more than 6-8 x a day.  Preservatives are toxic to the cornea, so using too often can cause more harm than good!

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