If you suffer from dry eye syndrome (DES), you are likely to find relief by using eye drops. However, there are many different eye drops to choose from, each with its own pros and cons. DES happens when the tear evaporates too quickly, or when people no longer produce the right amount of tears. This results in irritation of the eye.
At the Dry Eye Workshop (DEWS), dry eye was defined as being a multifactorial disease of the ocular surface and tears that leads to symptoms of tear film instability, visual disturbance, and discomfort. If left untreated, it can lead to damage to the ocular surface. Most people who suffer from DES also have inflammation of the ocular surface, as well as osmolarity of the tear film. This means that DES is not only uncomfortable, it also affects vision.
It is not known exactly how many people have DES at present. However, it is estimated that between 5% and 30% of people in the United States have it. It is also known that women are more likely to develop DES, as are older populations. The effects of DES are quite significant, not in the least due to the cost of finding treatment, being tested, and losing working hours. It also has a significant negative impact on overall quality of life.
Treating DES
There are many treatment options available for DES, broadly subdivided as:
- Artificial tears or rewetting agents
- Anti-inflammatory drugs, such as oral fatty acids and topical steroids
- Punctal plugs
- Secretogogues
- Moisture goggles
- Prescription oral and topical immunomodulatory drugs
- Autologous serums
- Surgery
To properly treat DES, it is important to first find the underlying cause. However, due to its multifactorial nature, it can be very difficult to do this. What makes it even harder is that there isn’t a single test to provide a correct diagnosis, although ocular surface inflammation is commonly seen.
Artificial Tears
Artificial tears are the most common type of treatment for people with DES. There are many different rewetting agents available, some over the counter and others on prescription only. Their goal is to replace tear volume and/or lubricate the surface of the eye. Unfortunately, it has not yet been possible to fully replicate the human tear, as the tear film is highly complex. Nevertheless, manufacturers are trying by changing the solution’s osmolarity, viscosity, and/or composition. Usually, people will have to try several eye drops before finding one that works best for them, and it is also common for people to have to regularly change their brands as the eye becomes accustomed to it.
Reviews of the Best Lubricant Drops for Dry Eye
The table below highlights some of the most commonly found solutions for dry eye syndrome, and how they compare.
| Type | Details | Brands | Pros |
| CMC-based artificial tears | These are a type of polysaccharide that is also known as a mucilage. CMC-based artificial tears contain caboxymethylcellulose. CMC-based artificial tears are generally available with and without preservatives. | · Refresh by Allergan. Refresh Liquigel in particular has been shown to significantly reduce the signs of DES.
· TheraTears by Advanced Vision Research, which is a hypotonic solution, which addresses hyperosmolarity, common in people with DES. |
· They increase the tears’ viscosity and residence time.
· They closely match the composition of human tears. · May protect ocular surface integrity. |
| HMC-based artificial tears | These contain hydroxypropyl methylcellulose. | · Bion Tears by Alcon, which is preservative-free and is most suitable for people with severe DES.
· Tears Naturale, which is available both with and without preservatives. · Visine Tears by Pfizer, available with or without preservatives. · GenTeal by Novartis, which is available in three formulations depending on the severity of DES. |
· Promotes surface integrity.
· Lubricates the surface of the eye. · Available for mild to severe DES. |
| HP guar-based artificial tears | These contain HP guar, which forms a gel. This is a unique approach that allows the artificial tear drop to be retained for longer. These products are particularly suitable for people with evaporative DES, including Meibomian Gland Disease, or for those who have stains on the ocular surface. | · Systane by Alcon | · It helps to recover the surface of the eye.
· Tear evaporation is significantly reduced. |
| SH-based artificial tears | These artificial tears include sodium hyaluronate (SH). Studies have shown that these tears are suitable for people with a range of different types of DES. | · Blink Tears by Abbott Medical Optics, which contains a preservative that disappears when exposed to light, meaning it is preservative free once it touches the eye. It is particularly suitable for those who experience post-LASIK DES.
· Blink Contacts by Abbott Medical Optics · AQuify comfort drops by CIBA Vision, which gradually releases water molecules, thereby relieving dryness related to lenses, and increasing wettability. |
· Generally suitable for contact lens wearers.
· Studies have demonstrated improvements in subjective DES symptoms. · Can be used by those with Sjogrens syndrome. · Protects the corneal epithelium. |
| PVA-based artificial tears | These contain polyvinyl alcohol, which lubricates the surface of the eye. These artificial tears exist both as gels and as drops. | · HypoTears by Novartis, which is available without or with preservatives.
· Tears Again by Cynacon/Ocusoft · Murine Tears by Murine Eye Care, which studies have shown to have the closest drop volume compared to natural tears. |
· Addresses hyperosmolarity problems.
· Highly affordable |
| Oil-based tears | These are usually based on castor oil or mineral oils, which help to regenerate the tear film’s lipid layer, while also slowing down evaporation. | · Soothe XP Emollient by Bausch & Lomb, which is based on a mineral oil.
· Refresh Endura by Allergan, which has been discontinued. |
· Improves tear stability.
· Can be used in Meibomian gland disease. · Increases the lipid layer’s thickness. |
| Rx Tears | Only one brand is available for Rx Tears at present, and they are available on prescription only. They contain polyvinyl pyrrollidone and PVA. Described as a phospholipid, it is very similar to oil-based artificial tears. | · FreshKote eyedrops by Focus Laboratories | · Helps to prevent evaporation.
· Stabilizes the lipid layer. · Provides better wetting because they address all elements of the hear. · High oncotic pressure, thereby improving the integrity of the surface of the eye. · Can be used as and when required. |
Unfortunately, there is not a single DES treatment that will work for everybody. Your personal symptoms, diagnosis, and complaints will help you to determine which drops will be best for your needs. There are distinct advantages to each option, and you should discuss these with your ophthalmologist to find the best one for your needs.
The table below highlights the most popular brands of eye drops available on the market today.
| Brand | Active Ingredient | Details | Use |
| GenTeal Gel for Severe Dry Eyes | Hydroxypropyl methycellulose 0.3% | Perfect for people with varying severity of DES caused by poor natural tear film quality. The film is substituted by GenTeal, preventing moisture loss at the cornea. | For those with DES due to low tear film quality. |
| Systane Ultra Lubricant Eye Drops | Propylene Glycol 0.3% and Polyethylene Glycol 400 0.4% | Perfect for those who experience irritation and burning with DES because their tear quality is low. The breakup time of the tear film is increased, which means it is better able to protect the surface of the eye between two blinks. | For those with DES caused by poor quality of the tears. |
| Refresh Tears Lubricant Eye Drops | Povidone 0.6%, polyvinyl alcohol 1.4% and tetrahydrozoline hydrochloride | Relieves DES irritation and burning common in those with insufficient tears. It is an extra strength product that mimics natural tears to keep the eye moistened. It also helps to reduce redness through local vasoconstriction in the eye. | Perfect for those who produce insufficient tears. |
Resources and References:
GenTeal Gel – Information on the GenTeal Gel Lubricant Eye Gel (Drugs.com)
Systane Drops – Information on Systane Ultra Preservative-Free Eye Drops (Systane.com)
Refresh Tears Drops – Information on Refresh Tears Lubricant Eye Drops (RefreshBrand.com)
