What are the recommended eye drops for dry eye syndrome?

Recommended Eye Drops for Dry Eye Syndrome

For dry eye syndrome, preservative-free artificial tears containing methylcellulose or hyaluronate should be used as first-line therapy, applied at least twice daily and increased to hourly as needed based on symptom severity. 1, 2

First-Line Treatment Options

Artificial Tears

• Formulation recommendations:
  • Preservative-free formulations are preferred, especially when more than 4 applications per day are needed 1
  • Key ingredients should include lubricants with polymeric base or viscosity agents:
    • Methylcellulose-based products
    • Hyaluronate-based products
  • Preservative-free artificial tears reduce iatrogenic effects of frequently applied medications 3

Application Schedule

• Start with at least twice daily application
• Increase frequency up to hourly as needed based on symptoms
• For nighttime relief, use thicker ophthalmic ointments before bedtime 1
  • Note: Ointments cause blurred vision, so they're best used before sleep
  • Follow with morning lid hygiene to prevent blepharitis

Treatment Algorithm Based on Severity

Mild to Moderate Dry Eye

1. Environmental modifications:

   • Humidify ambient air
   • Avoid air drafts
   • Practice conscious blinking
   • Lower computer screens below eye level 2
   • Identify and modify contributing medications (antihistamines, diuretics)

2. Artificial tears:

   • Preserved formulations acceptable if used ≤4 times daily
   • Switch to preservative-free if more frequent application needed

Moderate to Severe Dry Eye

If inadequate response to artificial tears:

1. Short-term topical therapy (2-4 weeks maximum):

   • Topical corticosteroids for acute inflammatory signs 1, 2
   • Monitor for increased intraocular pressure and infection risk

2. Prescription medications:

   • Cyclosporine ophthalmic emulsion 0.05% (Restasis) 2, 4
     • Targets underlying inflammation
     • Note: May cause burning/stinging sensation
   • Lifitegrast 5% ophthalmic solution (Xiidra) 2
     • Faster onset compared to cyclosporine
     • Improves both signs and symptoms over 3-month period

3. For refractory cases:

   • Autologous serum eye drops 1, 2
   • Consider referral to ophthalmologist with corneal disease expertise

Special Considerations

Contact Lens Wearers

• Remove lenses prior to administering eye drops
• May reinsert lenses 15 minutes after using Restasis 4
• Patients with decreased tear production typically should avoid contact lenses 4

Sjögren's Syndrome

• Consider serological workup if dry eye is severe or persistent 2
• May benefit from systemic therapies:
  • Oral muscarinic agonists (pilocarpine, cevimeline) 2
  • Cevimeline may have fewer adverse effects than pilocarpine

Application Tips

• Use immediately after opening single-use vials
• Discard remaining contents after application
• Do not allow vial tip to touch eye or any surface to prevent contamination 4
• Fixed dosing (four times daily) may provide better symptomatic relief than as-needed use 5

Cautions

• Avoid long-term use of preserved eye drops due to potential corneal toxicity
• Monitor for adverse effects with topical corticosteroids or NSAIDs:
  • Corneal-scleral melts
  • Perforation
  • Ulceration
  • Severe keratopathy
  • Increased intraocular pressure
  • Cataract development 1

Regular follow-up with an eye care professional is essential to monitor response to treatment and adjust therapy as needed, particularly for moderate to severe cases.