I think it is a good exercise for all optometrists to head to their nearest grocery store and go to the eyedrop aisle. Prepare to be overwhelmed and to spend about 10 minutes to read each of the brands and many options available to our patients. A lot of these brands use flashy TV advertisements or bold box designs to attract eye attention. I like to call it the peacocking effect: it’s no wonder patients are tricked subconsciously into buying one brand over another.
As a primary eye care provider, it is important to prescribe specific eye drops, even if they are over the counter products. It is even better to sell the products you recommend in office in order to increase compliance with prescribed drops and improve outcomes. Here are my favorite eye drops for every situation.
Best tears for Meibomian Gland Dysfunction (MGD) patients:
Systane Balance (propylene glycol 0.6%)
Systane Balance was scientifically engineered by Alcon to replenish the oil layer of the tear film which is deficient in MGD patients. Their LipiTech™ System is a proprietary technology that smoothly blends mineral oil and anionic phospholipids into the artificial tear which gives the tear its milky white appearance. Systane Balance is an excellent choice for our MGD patients and works even in advanced cases.
For those who need more than four drops of artificial tears a day to maintain ocular comfort, Retaine MGD (Light mineral oil 0.5% and mineral oil 0.5%) is an excellent tear. It comes in preservative free vials so can be used more than four times a day. It uses electrostatic attraction to evenly coat the ocular surface and remain there for extended relief. A word of caution to your patients: it can be difficult to find in box stores. Looking at Walgreens or online are your best choices.
Best preservative free tears:
Oasis Tears Plus (Glycerin 0.22%)
Preservative free (PF) tears are a great option for all patients, but they come at an increased cost. I urge preservative free tears for many different scenarios. Glaucoma patients on topical medications are already exposing their ocular surface to many preservatives such as BAK, and thus PF tears are an excellent option. Kids who come in experiencing discomfort due to viral conjunctivitis are another population that can benefit from preservative free tears. I advise parents to store the tears in the fridge for extra cooling relief. Lastly, I use PF tears in my scleral lens patients. They can either use a couple drops when filling their scleral bowl prior to insertion or over the top of the scleral lens throughout the day.
Oasis Tears Plus has a viscoelastic formula that spreads and thins during a blink in order to sustain the eye drop on your eye longer instead of discharging with a blink. They are not found in box stores, making them an excellent tear to stock and sell in office. They are easily available online.
Another excellent PF tear option is Allergan’s new Refresh Optive Mega-3 eye drop. Their tears boast three different active moisturizing ingredients including carboxymethylcellulose sodium 0.5%, Glycerin 1%, and Polysorbate 80 0.5%. These tears also contain castor oil and flaxseed oil to help replenish the lipid layer and are another good option for your MGD patients.
Best tears for aqueous deficient dry eyes:
Blink Tears (polyethylene glycol 400 0.25% plus Sodium Hyaluronate)
This category has the most available options, and they all work fairly similarly. My recommendation to you would be to have the patienttry multiple different types based on different active ingredients and lubricants. I believe that tears with Hyaluronic acid (HA) as an ingredient are superior to other forms of lubricants. Hyaluronic acid is a very viscoelastic lubricant and is found throughout the body due to its cushioning and lubricating properties. Studies have shown that HA formulated eye lubricants improve signs and symptoms of dry eye more rapidly than carboxymethyl cellulose-based artificial tears.1
Best tears for use with Contact Lenses:
Blink Contacts is my preferred tear for use with soft contact lenses. There will be no deposits on the lens and it provides lasting comfort and relief. I love that it has hyaluronate (hyaluronic acid) in it. It is so great that I use it even when I’m not wearing contact lenses.
Best tears for those with severe ocular surface disease:
FreshKote (polyvinylpyrrolidone 2.0% and polyvinyl alcohol 2.7%)
FreshKote is scientifically designed to support all three layers of the tear film: mucin, aqueous, and lipid layers. This is no easy feat due to the different static attraction and hydrophilic and hydrophobic properties of the layers of the tears. It is also safe to use with contacts. Iuse this drop for patients with severe SPK. It also works great as an adjunctive therapy for recurrent corneal erosion treatment. This is the most expensive eye drop in this list and should be preserved for those most in need. Another option for those with severe symptoms and OSD would be autologous serum tears.
Best drop for longer relief and nighttime use:
Refresh Optive Gel Drops (Carboxymethylcellulose sodium 1% and glycerin 0.9%)
This drop will cause blur upon instillation, which makes it bested used as a nighttime therapy. It works great for patients with nocturnal lagophthalmos or those who complain of waking up with dryness and discomfort. For even thicker and longer lasting effects, Refresh PM (mineral oil 42.% and White Petrolatum 57.3%) ointment can be used at night.
There are many artificial tears available over the counter for patient use. Your patients look to you for sound recommendation based on scientific evidence, ingredients, and previous patient’s satisfaction and review. I recommend stocking and selling 2-3 different types of eye drops in your office to ensure your patients follow your recommendations, for convenience, and for an added income generator. I currently sell Systane Balance, Blink Contacts, Oasis Tears Plus, and FreshKote.
While artificial tears are a great adjunct therapy, they are not a sole treatment. The only time I solely treat with artificial tears is for patients with mild, situational discomfort and no other underlying disease. I tell my patients that the goal of ocular surface disease treatment is to rely less on artificial tear supplements as we treat and improve the underlying condition.
- Mark B. Abelson, MD, CM, FRCSC, FARVO, George Ousler, Lisa Smith, and Urmila Santanam, PhDAndover, Mass. Bring Them to Tears With Your Treatment. Review of Ophthalmology. https://www.reviewofophthalmology.com/article/bring-them-to-tears-with-your-treatment. Published November 5, 2015. Accessed January 16, 2018.