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Best Artificial Tears + Side Effects

Artificial tears are a type of drops for the eyes that have been designed to help increase moisture on the surface of the eye and combat the symptoms of dry eyes. This condition of the eyes can be caused by a variety of factors, including the environment, underlying medical conditions, surgery, medication, or simply aging.

Artificial tears are available as over the counter remedy. There is no one brand that is the best out of all of them, and if you have to use them, you will usually find that you have to try quite a few before you find the one that is right for you. Do not opt for drops designed to fight eye redness, however, as these can actually cause irritation.

About Artificial Tears

Artificial tears are designed to lubricate the eye. Some have electrolytes added to them, which can help make the surface of a dry eye more moisturized. Others have thickening agents included, which help to keep the artificial tears on your eye’s surface for a longer period of time. The table below highlights the two main categories of artificial tears.

With Preservatives Without Preservatives
·         Contains preservatives – chemicals – that stop bacteria from growing in the solution after opening it.

·         Available in multi-dose bottles.

·         Preservatives can irritate the eye, particularly after prolonged use.

·         Best for those who use drops four times per day or more.

·         Best for people with moderate to severe dry eye syndrome (DES).

·         Generally sold in single-dose bottles.

Artificial tears are almost always in the form of drops, but gels and gel inserts do also exist. These are known as lubricants. Artificial tears are not, actually, ‘artificial tears’ because they do not have the same composition as real tears. This is why most medical professionals will refer to them as ‘ocular lubricants’ instead.

When you use artificial tears, you will have to experiment with which type works best for you, and when you should apply it. If you opt for a gel or gel insert, it is best to use the product at night before you go to bed, as it can cause blurring.

What Are Artificial Tears For?

Artificial tears are mainly used to treat mild to moderate dry eye symptoms. Generally, they are strong enough to provide relief for this condition. The following information may be of benefit to you if you are looking at which product to purchase:

  • Hypromellose is one of the most popular products and can be used very often.
  • If the product contains polyvinyl alcohol or carbomers, it is longer acting.
  • If it contains 0.9% sodium chloride, it is classed as a ‘comfort drop’ and is short acting.
  • Many products now contain sodium hyaluronate, which helps to retain water and has low blinking resistance.

It is important that you check whether the drops contain preservatives, as these can irritate your eye, particularly after prolonged use. If you wear soft contacts, or if you are known to have sensitive eyes, you should avoid preservatives.

Artificial tears can also be used to treat the symptoms of severe dry eyes. The following information may help you decide which product is best for you:

  • Always use artificial tears without preservatives. Use a lubricant ointment overnight as well.
  • Consider a paraffin-based eye ointment when you sleep, to protect the surface of the eye from epithelial erosion.
  • Do not use paraffin-based ointments when you wear contact lenses, or if you still need to use your eyes.
  • Find artificial tears with bicarbonate, as these have been shown to be most effective in the treatment of DES.

Artificial Tears Ingredients

The above should have demonstrated already that there are many different ingredients in artificial tears. However, the ones you will come across most often include:

  • Dextra
  • Carboxymethylcellulose
  • Hypromellose
  • Glycerin
  • Polysorbate
  • Polyethylene glycol 400 (PEG 400)
  • Povidone
  • Polyvinyl alcohol
  • Propylene glycol

The different ingredients work together to protect the eye from infections and injuries and to keep it moist. In so doing, they also reduce the common symptoms of DES, including the feeling as if a foreign object is lodged in the eye, itching, and burning.

How to Use Artificial Tears

Whichever artificial tears you end up buying, you must read the instructions first and follow them to the letter. If you don’t understand any of the directions, ask the pharmacist or your doctor. If you notice that the artificial tears are cloudy or have changed color, you shouldn’t use them. However, brands that contain polysorbates and glycerin may have a milky appearance. Check whether you need to shake the bottle before you use it.

In most cases, you can use drops as often as you want. Ointments, however, can generally only be used twice a day. As previously mentioned, it is best to only use them once, which is before you go to bed.

Before you apply the gel, drops, or other ointment, you must first wash your hands. Do not allow the dropper or tip of the tube touch the surface of the eye, as this could lead to contamination. Once you have applied the solution, make sure that the bottle is closed properly. Check whether you need to store it in the fridge or at room temperature. Make sure that you remove your contact lenses before you use drops or lubricants. Usually, you will not be able to wear your contacts while you use the drops at all, but this is something you need to check. If you have an infection in your eye, you should replace your contacts, as they will be contaminated.

Always make sure whether there are any known drug interactions with the solution. If you currently take any other medication, you may not be able to use the product. If you are, you may have to wait a few minutes before using the different medications.

If, after three days, your symptoms have not improved or have gotten worse, you should consult your doctor.

How to Apply Drops

The following steps describe how to apply artificial tear drops:

  1. Tilt your head back and pull your lower eyelid down. Tip the bottle upside down and hold the dropper above the pocket you have just created. Look away from the dropper and squeeze a single drop into the pocket.
  2. Close your eyes and tip your head down. Stay in that position for a few minutes. Do not squint or blink. After about two minutes, press the corner of your eye with your finger for another minute, so that the tears don’t drain out.

How to Apply Ointment

If you are using an ointment, you should:

  • Tilt your head back and pull your lower eyelid down.
  • Point the tip of the tube towards the pocket.
  • Look away from the tip.
  • Squeeze a line of ointment into the pocket you have created.
  • Blink once or twice, then close your eyes for a few minutes.
  • Wipe the excess off your eyelashes with a clean tissue.
  • Wait until your vision is no longer blurry before you drive or engage in activities.

Important Things to Know

  • Do not treat eye infections with artificial tears.
  • Do not use artificial tears if you have an allergy to any of the ingredients.
  • Check whether there are any drug interactions.
  • Check with the pharmacist or your doctor whether you can use the product if you are trying to conceive, pregnant, or nursing.

Overdose

The product you have chosen will indicate whether or not it is possible to overdose. In most cases, the product is harmful when swallowed and you must go to the emergency room or contact your nearest poison control center. Overdosing of lubricants can cause life threatening side effects, so only use it as often as required.

Side Effects

The following side effects have been reported as being common:

  • Blurred vision
  • Allergic reactions (difficulty breathing, hives, swelling of the throat, tongue, lips, or face). Stop using the product if you experience this.
  • Vision changes. Stop using the product if you experience this.
  • Eye pain. Stop using the product if you experience this.
  • Severe eye irritation, stinging, or burning. Stop using the product if you experience this.
  • Minor irritation
  • Watery eyes
  • Eye redness
  • An unpleasant taste
  • Photosensitivity
  • Swelling of the eyelids
  • Matting of the eyelashes
  • Watery eyes

Drug Interactions

We have already touched on the fact that artificial tears may have drug interactions. While it is rare for this to happen, it is important to be aware of it. This must be your own responsibility, as artificial tears are available as over the counter drugs. If you take any kind of medication, therefore, you must speak to your doctor or to the pharmacist to ask if you can use them.

Resources and References:

3,500 Years of Artificial Tears – History of efforts to treat the symptoms of dry eye syndrome. (Review of Ophthalmology)

Artificial Tears Potpourri: A Literature Review – Review of past literature on the effectiveness of artificial tears for treating dry eye syndrome. (NCBI)

Pilot Study on the Use of Artificial Tears to Treat Dry Eye in Glaucoma Patients (IVES) – Results of a study on the use of artificial tears to treat dry eye syndrome in people with glaucoma. (ClinicalTrials.gov)