Your eyes are dry, red, burning, and gritty. You decide you want to try something off the shelf first, or maybe a family member already has an eyedrop, but what are you even looking to try? There are so many brands. Maybe you've heard of Refresh or Systane, but there's a long line of products under those brand names. Or maybe your eye doctor mentioned warm compresses or eyelid scrubs. What do you use?
Your eye doctor will be able to let you know what factors are contributing to your dry eyes. Whether it's tear glands not producing enough tears, a problem with the meibomian glands, medications, or excessive computer use causing dry eyes, you can use the information below to help choose which products to try if a suggestion has not been made yet or you can't find the recommended products.
Artificial Tears:
The goals of using artificial tears are to provide relief from dry eye symptoms, lubricate the eyes, and protect the ocular surface. Let's take a look at the ingredients used in artificial tears to accomplish these goals.
Viscosity Agents: carboxymethylcellulose or CMC (Refresh products) , polyethylene glycol or PEG (Blink Tears), propylene glycol (Systane Complete), glycerin (Oasis Tears, Optase). These coat the surface of the eye to help lubricate and protect it. The higher the concentration, the thicker the eye drop. The more viscous drops (ex. Refresh Liquigel with 1% CMC vs Refresh Tears with 0.5% CMC) are better indicated for bedtime use due to the potential of blurring the vision, and the opposite is better for rewetting contact lenses. Artificial tears may list these agents as a single active ingredient, or they may be used in combination. Combination formulations (ex. CMC+ glycerin) have been found to be more effective than a single formulation and is utilized in the newer Refresh Relieva. Some studies also compared CMC to PEG and found that there was less damage to the cells on the surface of the eye after using artificial tears with PEG.
Oils: mineral oil (Systane Balance, Systane Complete), mineral oil and light mineral oil (Soothe XP, Retaine MGD), castor oil (Refresh Digital, Refresh Optive Advanced, Blink Triple Care), castor oil and flaxseed oil (Refresh Optive Mega-3). These oils contribute to the lipid layer of tears to seal in moisture. In most cases, artificial tears with oil in the ingredient need to be shaken prior to use. Those who have concurrent meibomian gland dysfunction benefit from lipid based artificial tears.
Inactive Ingredients: There are buffers and electrolytes in artificial tears to obtain a certain pH or osmolarity. Burning and stinging sometimes result when the pH of the artificial tear does not match the pH or the eye. TheraTears is more alkaline than most artificial tears and may be a good option in this case. In dry eye disease, the tears increase in osmolarity (ie. becomes saltier) because of either evaporation or low tear flow. Sodium hyaluronate is a humectant (water-absorbing) and can also lower osmolarity (Blink Tears, Oasis Tears, Optase line). Trehalose (Refresh Optive Mega-3, Optase MGD Advanced) and glycerin have protective properties on desiccated epithelial cells.
Preservatives: In multidose artificial tears, preservatives may be added to prevent bacterial growth once the bottle has been opened. However, some of these preservatives can be toxic to the ocular surface. Benzalkonium chloride (some of the Clear Eyes drops, many of the Rohto drops, Murine, Equate Tears) is one to avoid because it delays wound healing, damages corneal nerves, and can lead to irritation and inflammation. Newer artificial tears utilize softer preservatives such as Purite (Refresh family) and Ocupure (Blink family), which start to degrade when exposed to light. Because of potential irritation, some folks may benefit from preservative-free formulations. Non-preserved tears are great for those who have moderate to severe dry eyes needing to take artificial tears four times a day or more, are on glaucoma eye drops, have chronic allergies or skin sensitivities, or have experienced stinging when using lubricant drops. Preservative-free artificial tears typically come in small vials or special multi-dose bottles with a valve that blocks the uptake of fluid back into the bottle.
Lid Hygiene Products: In meibomian gland dysfunction, Staph and other bacteria tend to overpopulate the eyelids and excrete toxins that break down the lipid layer of tears. Cleaning the eyelid margins with baby shampoo may not be the best option. Hypochlorous acid, which is also used in wound care and dentistry, has found its way into ophthalmology. The best products contain pure hypochlorous acid (Hyclear, Avenova). There are also eyelid wipes and foam wash formulations that can be used to rid the lids of dirt and oily debris. These contain mild surfactants to help clean the lids and may include other ingredients like aloe vera to soothe the skin and phytosphingosine (Ocusoft) to form a protective skin barrier. Some use tea tree oil (Cliradex, Optase Tea Tree Oil Eyelid Wipes, Oust Demodex Cleanser), which is anti-inflammatory and is effective against eyelash mites but can irritate sensitive skin. Zocular products, on the other hand, take advantage of the anti-inflammatory properties of okra.
Warm compress:
An eyelid regimen including a warm compress is oftentimes suggested with dry eyes associated with an eyelid disease. The goal is to reach an effective and consistent temperature to help open up the meibomian glands and loosen the debris on the eyelashes. The target temperature is 40-45 degrees Celsius (no more than113 degrees Fahrenheit), and the target duration for therapeutic effect is 4-6 minutes. Both the Bruder mask and DERM mask can achieve this. One thing to note is that eyelid massage should not be performed during or immediately after the warm compress because this can cause corneal warpage.
Moisture goggles:
For dry eye sufferers who notice worse symptoms in the mornings upon waking up, incomplete eyelid closure and exposure to drafts and low humidity may be contributing to their symptoms. Eye Eco's Eyeseals 4.0 can use used to protect eyes from drafts, dust, leaking air from CPAPs and low humidity.
Because dry eye disease is so complex and multifactorial, the management plan can vary from one person to another. Once you know what problems to target, it becomes easier to sort out the products on the shelf. Luckily, most brands simplify their products with tags like “for moderate to severe dry eyes”, “digital” and “triple care”. I hope this article helps you become more familiar with these dry eye products and more successful in managing the condition.
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