Loading...
Dry eyes can make people miserable. You might feel as though you have sand in your eyes all the time. Your eyes may itch or sting. The first line treatment is to replace the tears your own eyes aren’t making. But how can you find a good eye drop to moisturize your eyes? That question is especially important now that the FDA has warned that many lubricant eye drops pose a problem. You can read our analysis of this problem at this link.
Brand Name Eye Drops vs. House Brands?
A reader of our nationally syndicated newspaper column asks:
Q. I’ve suffered from extremely dry eyes for more than three decades. However, my ophthalmologists have always recommended that I stick with single-dose packaged drops, containing no preservatives, and not generic brands.
I’ve always wondered if this is really necessary, since these drops are certainly pricey. With the recent recall, though, I’m thinking maybe these precautions are appropriate. I suppose even the name brand, single-dose drops could be subject to contamination. Honestly, I cannot live without these drops, and I hope you can reassure me.
A. The FDA’s warning about eye drop problems involves house brands from CVS Health, Leader, Rugby, Target, Rite Aid, Velocity and Walmart’s Equate Hydration PF Lubricant Eye Drop. These were all multi-use bottles containing 10 to 15 ml.
As far as we can tell, brand name products such as Systane, Refresh, TheraTears or Blink products are not included on the FDA’s problem list. Single-use artificial tears are also less likely to pose a problem.
Looking for a Good Eye Drop:
Another reader asks:
Q. Can you tell me if there are any eye drops without preservatives? I heard on your radio show that I should avoid benzalkonium chloride. I can’t find eye drops that do not contain that chemical. Can you help?
A. Look for a product that is preservative free. One such is TheraTears. Others include Systane Ultra, Refresh Optive Advanced and NanoTears TF.
Our guest expert, Dr. Peter McDonnell, director of the Wilmer Eye Institute, suggested a product with hyaluronic acid. One such is Hylo-Vision HD. You can listen to our interview with Dr. McDonnell about dry eyes. It is show 1154: How to Take Good Care of Your Eyesight.
Other Approaches to Overcoming Dry Eyes:
Blink:
There are several other approaches that may be helpful for dry eyes. One of the simplest is to blink frequently. Blinking is like breathing. You do both without thinking thousands of times each day.
As long as everything is going well you won’t even notice when you blink. You also won’t be aware if you forget to blink. When you watch a video on your smart phone or get caught up in correspondence on your computer you may be so focused that you fail to blink frequently enough.
That may not seem like a big deal, but blinking is critical for spreading tears over the surface of the eye and keeping it moist, clean and well nourished. Infrequent or incomplete blinking may be contributing to an apparent epidemic of dry eye. A Wall Street Journal article (July 9, 2013) notes that as many as 25 million Americans suffer from this malady.
Optometrists and ophthalmologists are diagnosing this condition in increasing numbers of patients, who describe a persistent sensation of grit or sand in the eye. Sometimes dry eye feels like burning that becomes more intense as the day wears on. Severe dryness can damage the cornea, creating a vicious cycle of pain and dysfunction.
Why Blink?
Over the last several years, research has shown that tears are more than just salty water. In addition to the aqueous (watery) part of tears, the eyelids have glands that secrete a thin film of oil. Every blink brings the top and bottom lids together and they squeeze each other gently. This helps the glands release oil that floats atop the watery portion and keeps it from evaporating too quickly.
If you don’t blink often or hard enough, the oil will stay in the glands, thicken and eventually plug the opening. While eye drops can replenish the liquid, eye doctors have been challenged to help patients restore the natural oil.
LipiFlow to Restore the Oil Coating:
The LipiFlow machine warms and presses the eyelids to unclog the glands and get the oil flowing again. One study compared LipiFlow to warm compresses (the usual recommendation) and found the device was significantly better (Cornea, April 2012). For most people, one treatment can ease dry eye symptoms for up to a year (Clinical and Experimental Ophthalmology, online, Dec. 14, 2012). The downside of LipiFlow treatment is that it is expensive and it does not work for everyone.
Ask Your Doctor About Sjögren’s Syndrome:
Sjögren’s syndrome is an autoimmune condition that can cause dry eyes as well as dry mouth. Because it isn’t limited to the eyes, doctors may treat this condition with systemic medications as well as prescription eyedrops. Drugs for rheumatoid arthritis such as hydroxychloroquine or methotrexate can also help control Sjögren’s syndrome.
Nutritional Supplements:
Some people have good results taking a supplement of omega-3 fatty acids. These seem to improve the quality of the oil produced by the eyelid’s meibomian glands. That helps keep the tears from evaporating off the surface of the eye.
DCF reported:
“After I went through menopause I had eyes so dry I’d have to take pain relievers every day. My work consists mostly of reading, writing, and using a computer monitor, so the dry eyes were a constant bother. Upon reporting this to my optometrist, I was advised to take 3 Thera-Tears Nutrition gel tablets, which consist of flaxseed oil and fish oil, daily at breakfast.
“Voilà! The Thera-Tears made all the difference in the world; I take them faithfully every day. No side effects, either.”
Lulu had a similar experience:
“My ophthalmologist told me to take a fish and a flax capsule in the morning and a fish and flax at nite…it works for me as I do not have to use an eye drop.”
MW also appreciates flaxseed oil:
“My doctor prescribed eye drops, but she also said that she takes 3000 mg of flaxseed oil every day. I started taking it about a month ago and it has made a tremendous difference.
“The supplements that I bought were only 1300 each so I take two, making it only 2600 per day. It’s worked like a charm.
“My ophthalmologist says that when she stops taking the flaxseed oil, she notices the dryness comes back within a short period of time. I did the hot compress, lid scrubs, etc and it made little difference but flaxseed oil works better.”
Pay Attention to Medications:
Dozens of medications can contribute to dry eyes. Antihistamines such as cetirizine (Zyrtec), loratadine (Claritin) and diphenhydramine (Benadryl) can do it. So can drugs for overactive bladder like fesoterodine (Toviaz), oxybutynin (Ditropan) and tolterodine (Detrol). Antidepressants such as amitriptyline, citalopram, doxepin, fluoxetine and sertraline may also trigger dry eye discomfort for some people. You will find a more comprehensive list here.
Do You Need a Prescription Eye Drop?
If over-the-counter artificial tears do not reverse the symptoms of dry eyes, an eye doctor may prescribe a more powerful eye drop. One such product is cyclosporine (Restasis). Another is lifitegrast (Xiidra). Both act on the immune system to reduce inflammation in the eye. Before accepting a prescription for either one, ask your doctor how likely it is that it will help you. Not everyone benefits, and Xiidra, in particular, is extremely expensive. Both may cause blurred vision as a side effect.
To learn more about a variety of dry eye treatments, you can listen to another expert guest from our radio show. We highly recommend this free podcast. You can listen to the streaming audio by clicking on the arrow inside the green circle below the photograph of our expert ophthalmologist. She provides lots of practical advice at this link. Please share your own experience with DED (dry eye disease) in the comment section below.
Betsy
This article doesn’t discuss the other symptom of dry eye disease, over-tearing. While it seems counterintuitive, my dry eye disease was diagnosed because of excessive tearing. I use eyedrops to KEEP my eyes from tearing so much but I don’t understand the reason for it.
Jim
I’m in my 80s and have been seeing a dry eye specialist for close to a year. He told me to use hot compresses twice a day for several minutes, the most convenient being a mask warmed in a microwave. (The Optase Moist Heat Eye Mask was a specific recommendation.) Also, there’s a preservative-free, OTC eye drop he prescribed for my Meibomian Gland Dysfunction: OCuSOFT Retaine MGD Ophthalmic Emulsion (drops in vial). He also encouraged me to get more Omega 3 oils in my diet and/or via supplements, with Flax Seed Oil being the preferred supplement and to do squeeze eyes shut then blink-blink-blink several times a day. My eyes are MUCH improved, over a period of several months.
Sue
I rub castor oil on my eyelids. I massage with my fingers with eyes closed and rub all around my eyes. I do this morning and night and it is greatly cut back my need for using eye drops.
Tina
I’ve had dry eyes for years, mostly caused by a combination of seasonal allergies, hypothyroidism, and genetics. I used to be a fan of Similisan, but when I had to use their drops more and more often, I was disturbed by the preservatives and ended up switching to Boiron Optique1, which comes in individual little vials. My biggest complaint is the environmental impact, and the second is the cost, but my eyes only require one mini-vial per day, max, versus multiple drops of the Similisan. This is one of the few occasions that I am grateful for having a capricious immune system that reacts to so many things (I have Mast Cell Activation Syndrome), because I am healthier for not introducing toxins into my body that cause far more harm than good.
Mary
My Optometrist recommended Oasis preservative-free eye drops over all the OTC brands. They gave me a sample & I ordered from Amazon. Awesome drops. I’m also noticing improvement with a heated eye mask for sleeping. It has worked wonders. Comes with its own charger, and works for 20min. You can long press the button for up to three times for high heat (which I use) and short press for low heat. A side benefit from this eye mask is that I notice a clearing of my sinuses and the lipid pouches on either side of my eyes also goes down temporarily.
Sue
I have used Refresh Optive Advanced eye drops three times a day for several years now — very helpful!
And, as the eye doctor advised, I remind myself to blink now and then, especially while looking at the computer screen for hours!
Marsha
After having covid, I had really bad dry eyes and the itching nearly drove me crazy. Recently I had cataract surgery and it got even worse. I started experimenting and started taking 3 of the 5000 mcg B12 which are sublingual. Also 1/2 tablet of the sublingual B complex , Post covid or also partly due to aging (I am 78), absorbing food nutrients or tablet supplements has been difficult so I try to take easy absorbable supplements. liquid minerals, powdered vitamin C, sublingual B’s. I’ve had no more need for eyedrops in the heat is off seasons. I run a vaporizor in the heating season in my bedroom.
Taking fish oil helped some. Ivizia eyedrops helped the most before taking the sublingual B’s.
Joanne
I use Hycosan extra for my dry eyes and love it. It’s produced in Germany and available on amazon. Recently, I even used their ointment which worked really well. There are no preservatives and it comes in a container which prevents contamination.
MARY
I use Similasan for all eye issues.
George
My ophthalmologist asked me how much caffeine I consumed in a day and suggested that I cut back as well as make sure I stay hydrated. The suggestions helped a great deal, and my eyes are not nearly as dry as they were.
Sherri
After 3 years and 3 opthamologists, I have been diagnosed with SLK whose symptoms started out like dry eye, and no pharma regimens helped. If your dry eye is not responding to treatment, ask you doctor about SLK. This has been life changing to finally get the proper diagnosis, so I can get the proper treatment.
Jen
Warm compresses are also a good treatment for dry eye especially if you are older. The oil in your glands tends to get thick as you age, and the warm compress helps to thin it out.
Mela
Nothing helped me until I got Okuzell lipidspray in Europe. It contains 0.1% hyaluronic acid and is sprayed on the closed lid. It worked like a miracle. Could not find it here yet…
Terry Graedon
Okuzell is a brand name for hypromellose. It is available under these brand names in the US: Genteal
Genteal Mild
Gonak
Goniosoft
Goniovisc
Isopto Tears
Nature’s Tears
Tearisol
Tears Again Mc
Ronnie
I just discovered supplement sea berry. I recently went thru a session with burning eyes (because of cold like symptoms with my noise). Started this past Sunday when they arrived at my door with two gel capsules), and I could feel a difference immediately. Now five days in, and my eyes feel fantastic! Yes, I still may use drops (which in the past were useless with that hot burning pokers in my eyes feeling) and a hot compress, but the need is not as urgent since I started with sea berry. I’m so sold, I may just start a subscription (not sold in stores).
Meryl
After menopause I suffered from dry eye and also had a bad reaction to preservative in eye drops so went to preservative free. I also discovered that taking an oral supplement with hyaluronic acid helps a lot for me. I was taking it for my joints without making the connection that I had been needing to use the drops less often. I ran out of the hyaluronic supplement and hadn’t gotten it replaced, and my eyes started “weeping” and over-compensating for the dryness coming back. I started back on the oral, and after a bit I was again rarely having to use the drops.
Barbara D
Michigan
OMG I started using Flax seed oil after reading this in. It’s a godsend. I found that 2 TBSP is the right amount for me. My eyes are still dry upon awakening, but otherwise, no drops til maybe l0:00 pm then just once. I was having to use them almost hourly. Thank you to those who shared!!
Peter
UK
The article mentions that blinking enough is an important factor in keeping the eyes moist and lubricated.
There is an app called VisionProtect that helps with keeping a healthy blink frequency:
https://sites.google.com/view/visionprotect
It is a training programme for the eyes. If you find yourself not blinking frequently enough (dry eyes in front of a computer), give a try to VisionProtect.
Barbara D
Michiga
So far, the Flax Seed Oil has helped. I use the liquid and swig 2 tsp ( a slight Tabelspoon) every morning. Not fond of the taste. Might try capsules next time. I already take lots of Omega 3 Fish Oil. All this info has helped.
Linda
I get burning dry eyes after too much screen time or driving long distance. My eye doctor had me try several drops just before leaving on a trip. Systane and Gen_teal work well, but the best was the gel version. I keep it in the fridge(all eyedrops feel magical when chilled) and put the gel in 10 minutes before leaving. I also keep some in my desk at work.
Sandy
Virginia
Was glad to see the preservative-free eye drops listed. Can these be used with soft contact lenses?
Colorado Conservative
Dry eyes have been an issue for me for at least 10 years. I had Lasik surgery which is attributed to the problem but most likely age, menopause, and climate are all factors. I do use prescription Restatis but still have to rely on OTC drops. For me preservative free BION Tears are one of the best (I order them online for the best price) and I recommend them highly. I also recommend using computer glasses if you are someone who is at the computer often. This has considerably decreased my need to use OTC drops when at the computer.
Suzy
Signal Mtn TN
I’ve used Thera Tears for year. It’s easy, safe, preservative free and it works great great?
Janet
Ashford, WA
I have extremely dry eyes, apparently from sleeping with my eyes partly open, but I also notice while reading or driving or anytime I am not blinking enough. My eye doctor found an incredible solution in Oasis Tears. They also contain hyaluronic acid, (state of the art DNA? ingredient) as noted above, yet you can order them online here in the US. They are very expensive, and I get the small single dose type as they have no preservatives. They are approximately one dollar a dose, and I use about 6-8 a day so very expensive for me. I hope a generic, or other option will come out with this ingredient. But they have saved my eyes from terrible infections, and keep them healthy. I use Oasis tears Plus at night and regular Oasis Tears in the day. Best of luck!
JJ
Watertown SD
My eye doctor recommended using Cleansing Eyelid Pads daily to keep the oils flowing so the oil ducts don’t get clogged. She also recommended warm compresses for about 6 minutes each time to soften the oils. This helps both with itchy eyes and dry eyes.
Lynn
midwest
Dry eye can be helped by small things like blinking. Also when on the computer the 20/20/20 rule is advisable. Every 20 minutes look 20 feet away for 20 seconds. When you stare at the computer monitor you tend to blink less. So blinking and looking away is important. I would also advise those with dry eye to be aware where their TV is.
If you watch a television that is high up, you eye is open father looking at it than if the TV is in a lower location. The same holds true for computers, That eye that is open further dries out more quickly. Each is best lower than the eye so you look down at them. Be aware of fans and heat in the car that they do not point directly to your eyes. If you use eye drops for lubrication more than 3 times a day, use drops without preservatives. Many brands have drops in vials and those are the ones that do not have preservatives as opposed to the bottled drops. There are also homeopathic drops that can help. Check your medications to see if they cause dry eye but also be aware that certain autoimmune diseases can cause it as well. One that is very common but not well known is Sjogren’s (show-grins). In Sjogren’s, dry eye occurs with dry mouth (which leads to dental decay) along with extreme fatigue and arthritic issues. Those with RA also can suffer from dry eye. If you are not sure what is going on, seek medical attention because dry eye can cause corneal abrasion in the eye.
sherry
If you have rosacea, you may have it in your eyes also. It feels like sand. Washing eyes with a soft soap like Cetaphil can help for short term relief. Getting rid of rosacea altogether is difficult.
Virginia
Georgia
Dry eye plagued me for years & my eye doctor was of little help even though she tried. At one point my eyes itched so badly that I felt like clawing my eyes out! I finally decided that the extreme itch was something other than just dry eye. I suspected a fungal skin infection around my eyes, so I tried an anti-fungal cream around my eyelids. It worked like a charm, just be certain not to get it into your eyes and I bought one tube just for my eyes so as to avoid any possible contaimination
Beth
I am unable to locate Hylo HD eyedrops. Does anyone know a source to purchase this product?
LaRae
AZ
After a procedure done on my eyes a while back, they would get very dry in the evening when I was tired. I put a couple of drops of organic virgin coconut oil in each eye and it worked wonders!
Pam
South Pasadna, Ca
Been taking Xiidra for about a year since I was allergic to Restasis. Has helped, but noticed lately my taste buds are loosing my ability to taste food and i’ve started having dry mouth during the night. Read the side effects and notice these could be a problem.
Am trying zinc supplements to restore my taste buds. Will wait and see. I’ve also tried biotene, helps somewhat. I had to ask for a formulary exception with my insurance Scan. Took a while but it was granted after i appealed their initial decision. Price went from $500 to $95. Worth the effort.
Jean
Chapel Hill, NC
With my eye doctor’s approval I have used Similsan eyedrops for some years. They have one for dry eye, allergy eye, and one for complete. They are all very good, and have no artificial ingredients.
Janie
Washington State
Washing my face often and with lots of water also helps with my dry eyes during allergy season, by ridding my face of pollen and dust.
Mary
A person must be very careful when using eye drops. Especially when a person had Cataracts removed from your eyes. Not all eye drops are made for that. That is why my eye surgeon gave me a prescription to get filled out just for dry eyes.
Christine
Chicago
I had dry eye and began taking Lutein and Zeaxanthin combination and it helped immediately no problem since,
Jan
UK
Hycosan, also marketed as Hyloforte are good effective drops, no preservatives, and useable for six months so although a bit expensive quite cost effective in the long run. I’m in uk so don’t know if available in US.
Suzanne
USA
If you get migraines do NOT use Restasis; many of us had a marked increase in the frequency and intensity of migraines from Restasis. My eye surgeon recommended Similason homeopathic drops. They do a better job, are much cheaper, and are OTC.