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.

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


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

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

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

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.

Ruman Amjad

Hello, I am Dr. Ruman Amjad, an Ophthalmologist specializing in the field of eye care, particularly focused on helping individuals with swollen eyelids. I am thrilled to welcome you to, a comprehensive resource dedicated to providing accurate and reliable information on eyelid inflammation.


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