Recommended Eye Drops for Hospice Patients with Allergies and Dry Eyes
For hospice patients with both allergies and dry eyes, use preservative-free artificial tears containing carboxymethylcellulose (0.5-1%) or hyaluronate at least 4 times daily, with lubricating ointment at bedtime for overnight protection. 1, 2
Specific Eye Drop Products by Active Ingredient
First-Line Artificial Tears (Preservative-Free)
- Carboxymethylcellulose-based drops: Refresh Plus (0.5%), Refresh Optive (carmellose sodium) 2, 3
- Hyaluronate/Hyaluronic acid-based drops: These are polymeric-based lubricants that serve as the mainstay of dry eye treatment 2
- Methylcellulose-based tears: Standard first-line option for dry eye management 2, 4
Overnight Protection
- Lubricating ointment: Apply to the eye at bedtime for overnight protection, particularly important in hospice patients who may have reduced blinking or incomplete eyelid closure 5
Lipid-Containing Supplements (If Meibomian Gland Dysfunction Present)
- Lipid-containing eye drops: Specifically beneficial when meibomian gland dysfunction contributes to evaporative dry eye 1, 2
Dosing Strategy for Hospice Setting
Frequency Guidelines
- Minimum frequency: At least 4 times daily for baseline symptom control 2, 5
- Increased frequency: Can be applied hourly based on symptom severity in hospice patients 2
- Preservative-free requirement: Mandatory when using more than 4 times daily to avoid ocular surface toxicity 1, 4
Formulation Selection by Time of Day
- Daytime: Liquid drops for ease of administration 2
- Extended relief: Gels provide longer-lasting effect when more sustained relief is needed 2
- Nighttime: Ointments for overnight protection 2, 5
Critical Considerations for Hospice Patients
Allergy Component Management
- Avoid preserved formulations: Many over-the-counter eye drops contain preservatives or vasoconstricting agents that can worsen symptoms 1
- Systemic antihistamines caution: Oral antihistamines commonly used for allergies may exacerbate dry eye complaints and should be used cautiously 6
- Nasal steroid benefit: If the patient is using nasal steroid spray for allergic rhinitis, this may actually improve dry eye symptoms without affecting intraocular pressure 7
Comfort-Focused Approach
- Carboxymethylcellulose 0.5%: Provides temporary yet significant improvement in visual acuity lasting approximately 3 minutes per application, which may enhance quality of life 3
- Fixed dosing superior to as-needed: Regular four-times-daily dosing provides better symptomatic relief than as-needed use, particularly important for symptom control in hospice care 8
Environmental Modifications to Enhance Eye Drop Efficacy
Simple Interventions
- Humidify ambient air and avoid air drafts by using side shields on spectacles 1, 2, 5
- Eliminate cigarette smoke exposure completely, as smoking adversely affects the tear film lipid layer 2, 5, 4
- Lower screen position below eye level to decrease eyelid aperture if the patient uses screens 2, 5
When Basic Artificial Tears Are Insufficient
Second-Line Options (If Appropriate for Goals of Care)
- Cyclosporine 0.05% (Restasis): One drop twice daily if inflammation is present, though this requires weeks to months for full effect and may not align with hospice timeframes 2
- Short-term topical corticosteroids: Dexamethasone 0.1% twice daily for 2-4 weeks maximum can decrease ocular irritation, but should be limited due to infection and intraocular pressure risks 1, 2
Common Pitfalls to Avoid
Preservative Toxicity
- Never use preserved artificial tears more than 4 times daily, as overuse causes ocular surface toxicity that worsens the underlying condition 2, 4, 9
Medication Interactions
- Recognize antihistamine effects: Systemic antihistamines for allergies commonly exacerbate dry eye complaints within hours of use 6
Inadequate Overnight Protection
- Always include bedtime ointment for hospice patients, as nocturnal lagophthalmos (incomplete eyelid closure during sleep) is common and worsens dry eye 5