From the Guidelines
Alternatives to artificial tears include punctal occlusion, autologous serum or plasma rich in growth factors drops, and oral medications such as cevimeline or pilocarpine.
Alternatives to Artificial Tears
- Punctal occlusion: can be accomplished by means of thermal or laser cautery, or by using punctal plugs made of materials such as silicone, collagen, or thermal labile polymer 1
- Autologous serum or plasma rich in growth factors drops: have been reported to improve ocular irritation symptoms and conjunctival and corneal dye staining in patients with Sjögren’s syndrome and GVHD 1
- Oral medications: such as cevimeline or pilocarpine, which are cholinergic agonists that stimulate secretion of the salivary and sweat glands and improve tear production 1
- Rigid gas-permeable scleral lenses: have been used successfully in the treatment of severe dry eye, but may be limited by fitting difficulties, cost, and patient willingness and ability to manage lens insertion and removal 1
- Soft contact lenses: may provide symptomatic relief in selected cases, but may be poorly tolerated if the patient has severe dry eye 1
- Varenicline nasal spray: a highly selective nicotinic acetylcholine receptor agonist that works as a neuroactivator of tear film production, has been FDA approved for treatment of signs and symptoms of dry eye syndrome 1
- Perfluorohexyloctane ophthalmic drops: a novel, nonaqueous, single-entity, preservative-free ophthalmic drop that has recently obtained FDA approval for the management of signs and symptoms of dry eye 1
From the Research
Alternatives to Artificial Tears
- Autologous serum eye drops: Studies have shown that autologous serum eye drops may be a beneficial alternative treatment for dry eye disease, with some patients perceiving them as even better than artificial tears 2, 3, 4.
- Cationic emulsion tear substitutes: These have been developed to mimic the healthy tear film and have been shown to improve dry eye disease symptoms and objective parameters 5.
- High-molecular-weight hyaluronic acid eye drops: These have been found to be an acceptable alternative to autologous serum eye drops, with some patients preferring them over autologous serum 3.
- Carboxymethylcellulose (CMC), polyethylene glycol (PEG) 400, or sodium hyaluronate (SH)-based lubricants: These artificial tears have been shown to have similar effects on noninvasive tear film parameters, with patients reporting better relief with SH-based lubricants 6.
Comparison of Alternatives
- Autologous serum eye drops vs. artificial tears: Low-certainty evidence suggests that autologous serum eye drops may provide some improvement in participant-reported symptoms and ocular surface outcomes compared to artificial tears 4.
- High-molecular-weight hyaluronic acid eye drops vs. autologous serum eye drops: Some patients have been found to prefer high-molecular-weight hyaluronic acid eye drops over autologous serum eye drops 3.
- Cationic emulsion tear substitutes vs. other artificial tears: Cationic emulsion tear substitutes have been shown to have superior efficacy on dry eye disease symptoms compared to several other available artificial tear formulation types 5.