Monday, September 20, 2021

Top 5 Over The Counter Eye Drops for Dry Eyes

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In today's article, I would like to talk to you about the top 5 choices of the otc dry eye drops. These are the best artificial tears eye drops to treat dry eyes disease.

I recommended these drops on the basis of my clinical experience treating dry eyes disease in my practice and the in-depth research I did about the science behind the ingredients of different artificial tears. If eye drops are not enough, other best treatment options are available to treat dry eyes.

As a LASIK surgeon and cornea specialist, I often get patients with varying severity of dry eyes disease referred to me by other eye doctors. For each of my patients with dry eyes disease, I give them a written customized treatment plan.

All of the treatment plans include one or more over-the-counter artificial tears and I specify which type of artificial tears that I recommend. However, if you are going to a pharmacy to choose artificial tears on your own, the choices may be overwhelming.


There are typically more than 20 to 30 different types of artificial tears available over-the-counter. How do you know which one is the best dry eye drop for you? In this post, I will guide you about the science behind my top five picks of artificial tears for treating dry eyes disease and help you understand the differences between them.

Without further ado, let's talk about artificial tears. Artificial tears are intended to supplements the natural tears that are made by the tear glands in our eyes. Natural tears lubricate the surface of our eyes by forming a tear film. The tear film has three layers:

The most outer layer is called the lipid layer, This layer functions as a protective barrier to prevent tears from drying up too fast.

The middle layer is called the aqueous layer, this watery layer contains the moisture we need to keep the surface of our eye lubricated.

The most inner layer of our tear film is called the " Mucin layer", the mucin layer functions as a bridge to keep the tear film attached to the surface of our eye it is called the cornea and it is the clear windshield of our eye. An ideal artificial tear should be able to supplement all three layers of our tear film.

Top 5 Artificial Eye Drops for Dry Eyes

I have divided my best 5 favorite artificial eye drops into two groups based on the severity of the dry eye disease;
  • Mild to moderate
  • Moderate to Severe
And I will list the top three artificial tears that I recommend for mild to moderate dry eye disease, as well as my top two picks to treat moderate to severe dry eye disease.

1. Systane Complete Eye Drops

Systane complete eye drops made by Alcon. It comes in a 10 mL bottle and uses poly quad as its preservative. The reason I like it is that it uses Nanodroplet technology, which is a type of nanoemulsion drug delivery system using negatively charged submicron-sized carrier particle to provide greater surface area to improve the stability and absorption of the drop.

Systane complete eye drop addresses all three layers of the tear film as it contains polyethylene glycol as its active ingredient to form a protective layer over the mucous membrane on the surface of the eye to provide hydration as well as reduce inflammation.

In addition to that, it contains hydroxypropyl guar, AKA HP guar. It is a pH-dependent molecule that can form a cross-linked network, which merges with the natural tear film to form a protective layer to cover the damaged epithelial cells on the surface of the cornea. This allows the damaged epithelial cells to be able to repair themselves in a protective space.

In addition to that, Systane complete eye drop contains mineral oil which targets the lipid layer of the tear film to prolong the effectiveness of the eye drop by reducing evaporation of the eye drop and the aqueous layer of the tear film. This helps to retain moisture on the surface of the eye longer.

2. Refresh Relieva Eye Drops

My number two pick for mild to moderate dry eye disease is Refresh Relieva made by Allergan. It contains active ingredients of carboxymethylcellulose sodium or CMC as well as glycerin.

Both of the ingredients are water-soluble polymers that have characteristics similar to natural tears and therefore they can lubricate the surface of the eye with minimal disruption of the natural tears. The glycerin can decrease the osmolarity of the tear film on the surface of the eye to provide additional lubrication and promote epithelial cell growth.

Among the inactive ingredients, it contains sodium hyaluronate that helps to repair corneal epithelial cells and lower the tear film osmolarity.

The preservative used in refresh relieva is the purite oxidative preservative. Another reason I like refresh relieva is that it comes in both preservative-containing and preservative-free forms.

One of the unique things about refresh relieva is that its preservative-free version comes in a multidose 10 mL bottle and this packaging wastes a lot fewer drops and uses much less plastic packaging material compared to the single-use vial packaging. It saves money and it's convenient.

3. Refresh Digital Eye Drops

My favorite otc dry eye drop for mild to moderate dry eye disease is "refresh digital" artificial tears made by Allergan. The difference between refresh digital versus refresh relieva is the added emollient component in refresh digital artificial tears.

Refresh Digital artificial tears contain castor oil which is a natural ingredient derived from castor beans. It targets the lipid layer of the tear film by reducing evaporation of the tear film and extending the effectiveness of the artificial tears.

Besides, CMC and glycerin, an additional active ingredient in refresh digital is a polysorbate. Polysorbate can help blend the oil component and the water-soluble component of the artificial tears to make the eye drop more soluble and easily spread across the surface of the eye.

The preservative used in refresh digital is the purite oxidative preservative. I do wish the refresh digital preservative-free was also available in the multidose bottle to reduce waste.

In moderate to severe dry eye disease, people often need to use artificial tears very frequently throughout the day due to the severity of the surface dryness.

Sometimes as often as every hour to every two hours. It is very important for people with moderate to severe dry eye disease to use preservative-free artificial tears to prevent any toxicity from such frequent application of the preservative onto the surface of the eye.

4. Refresh Celluvisc Eye Drops

One of my two favorites over-the-counter dry eye drops that can be used daily is "Refresh celluvisc". It is preservative-free and contains the active ingredient of 1% CMC. This is double the concentration of the CMC contained in other types of refresh eye drops. The increased concentration of CMC will allow the artificial tears to stay much longer on the surface of the eye.

However, because of the higher concentration of CMC. Celluvisc is a fairly thick eye drop, I often remind my patients who are using it that because the eye drop is very thick you may experience blurry vision for a couple of minutes after putting it in, make sure you blink a few times after putting in the drop and don't put in the drop right before driving or operating other machinery.

5. Genteal Tears Eye Drops

The other best dry eye drop for moderate to severe dry eye disease is "Genteal Eye Gel" made by Alcon. Genteal Gel is the thickest eye drop among my top five favorite artificial tears. It comes in a gel consistency and contains hypromellose 0.3%. Hypromellose is short for hydroxypropyl methylcellulose or HPMC.

It is an active ingredient to increase the viscosity of the eye drop, to extend the lubricating quality of the eye drop. HPMC can cross-link when contacting the surface of the eye to slow down tear film evaporation.

Genteal Gel provides long-lasting lubrication to the surface of the eye. Because of its long-lasting lubricating quality, I typically recommend my patients with severe dry eye diseases to use Genteal Gel four times a day including at night before going to bed. And also because it is a gel form, it causes less blurry vision than most over-the-counter eye ointments.

It is important to remember Genteal Gel can still cause some blurry vision shortly after putting in the eye drop. So it is important not to put in the drop right before driving or operating other machinery. The preservative used in Genteal Gel is sodium perborate, brand name Genaqua. It is an oxidative type of preservative. 

I hope this article is helpful in learning more about the science and logic behind artificial tears, and that this article will help you to pick the artificial tears that work best for you. Please let me know which over-the-counter artificial tears are your favorite in the comments.

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