What are the treatment options for dry eye syndrome, specifically artificial tears (eye drops)?

From the Guidelines

For dry eyes, start with over-the-counter artificial tears, specifically preservative-free options like Systane Ultra or Refresh Optive, used 4 to 6 times daily, or as needed for symptom relief, as recommended by the most recent guidelines 1. When selecting artificial tears, consider the viscosity and preservative status, as thicker agents may provide longer-lasting relief but can cause blurred vision, while preservative-free options are recommended for frequent use 1. Key considerations for treatment include:

• Using artificial tears as the first line of treatment for mild dry eye syndrome, with the option to increase frequency or switch to thicker agents like gels or ointments as needed 1
• Addressing contributing factors such as blepharitis, meibomianitis, or eyelid abnormalities, which can exacerbate dry eye symptoms 1
• Implementing lifestyle changes, including humidifying the environment, taking regular breaks from screen time, and staying hydrated, to reduce tear evaporation and support overall eye health 1 For nighttime relief, consider a thicker gel or ointment like GenTeal Gel or Refresh P.M., applied inside the lower eyelid before bed, which can provide longer-lasting moisture but may temporarily blur vision 1. If symptoms persist after two weeks of consistent use, consult an eye doctor, who may recommend prescription options like Restasis or Xiidra, which can increase natural tear production 1.

From the FDA Drug Label

Cyclosporine ophthalmic emulsion, 0.05% demonstrated statistically significant increases in Schirmer wetting of 10 mm versus vehicle at six months in patients whose tear production was presumed to be suppressed due to ocular inflammation.

The treatment option for dry eye syndrome, specifically artificial tears (eye drops), is cyclosporine ophthalmic emulsion, 0.05%, which has been shown to increase tear production in patients with moderate to severe keratoconjunctivitis sicca 2.

• Key benefits: statistically significant increases in Schirmer wetting of 10 mm versus vehicle at six months
• Patient population: patients with moderate to severe keratoconjunctivitis sicca whose tear production is presumed to be suppressed due to ocular inflammation
• Important note: increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs 2 2

From the Research

Treatment Options for Dry Eye Syndrome

• Artificial tears (eye drops) are the most common form of treatment for dry eye syndrome, with various formulations available, each with its own mechanism of action 3.
• The choice of artificial tear formulation can be guided by simple guidelines, taking into account factors such as the severity of dry eye, tear acidity, and potential side effects like burning on instillation 3.

Artificial Tear Formulations

• Different artificial tear formulations have been compared in studies, including Rohto Dry-Aid and Systane Ultra, which showed comparable effects on the signs and symptoms of dry eye disease 4.
• Preservative-free artificial tears containing hyaluronate, such as Hyabak, have been shown to provide clinical benefit in patients with dry eye disease, improving ocular surface disease index (OSDI) scores and reducing the frequency of superficial punctate keratitis (SPK) 5.
• A meta-analysis of randomized controlled trials found that 0.2% polyacrylic acid-based artificial tears were more effective at treating dry eye symptoms than 1.4% polyvinyl alcohol-based artificial tears, but the overall quality of evidence was assessed as low due to high risks of bias and poor reporting of outcome measures 6.

Predicting Optimum Artificial Tear Treatment

• A study found that the optimum artificial tear treatment for dry eye disease could not be predicted from presenting signs and symptoms, as different treatments had similar effects on ocular symptoms and signs, but individual preferences varied 7.
• However, the study suggested that osmolarity balanced artificial tears may be preferred by individuals with low baseline tear volume, and liposomal spray may be preferred by those with a baseline lipid layer deficiency 7.