What eye drops can I use to treat dry eyes?

Eye Drops for Dry Eyes

Start with preservative-free artificial tears containing methylcellulose or hyaluronic acid as first-line therapy, using them at least twice daily and increasing frequency based on symptom severity. 1

First-Line Treatment: Artificial Tears

Recommended Formulations

• Methylcellulose-based tears or hyaluronic acid/hyaluronate-based tears are the mainstay of dry eye treatment and should be your initial choice 1, 2
• Carboxymethylcellulose (0.5-1%) and carmellose sodium are also effective options 1
• Dual-polymer formulations (such as hydroxypropyl guar with hyaluronic acid) provide synergistic benefits by forming a protective gel matrix on the ocular surface while stabilizing the tear film 3, 4

Preservative Considerations

• Use preservative-free formulations when applying more than 4 times daily to avoid ocular surface toxicity 1, 2
• Preserved tears are acceptable only for mild use (≤4 times per day) 1
• Overuse of preserved artificial tears can cause direct toxicity to the ocular surface 1

Application Strategy by Timing

• Use liquid drops during daytime for immediate relief 1, 2
• Apply gels for longer-lasting effect when extended protection is needed 1, 2
• Use ointments at bedtime for overnight protection 1, 2

Special Formulations for Specific Conditions

• Lipid-containing eye drops should be used specifically if meibomian gland dysfunction is present, which commonly accompanies dry eye 1, 2

When to Escalate Beyond Artificial Tears

Second-Line: Anti-Inflammatory Agents

• Add cyclosporine 0.05% (Restasis) twice daily when artificial tears fail to adequately control symptoms after 2-4 weeks 1, 2
• Cyclosporine prevents T-cell activation and inflammatory cytokine production, with success rates of 74% in mild, 72% in moderate, and 67% in severe dry eye 1
• Lifitegrast 5% (Xiidra) is an alternative that blocks LFA-1/ICAM-1 interaction and improves both signs and symptoms 1

Short-Term Corticosteroids

• Use topical corticosteroids for 2-4 weeks maximum during acute exacerbations to decrease ocular irritation and corneal staining 1, 2
• Never extend corticosteroid use beyond 4 weeks due to risks of infections and increased intraocular pressure 1, 2

Essential Adjunctive Measures

Environmental Modifications

• Eliminate all cigarette smoke exposure completely, as smoking adversely affects the tear film lipid layer 1, 2
• Humidify ambient air and use side shields on spectacles to minimize air draft exposure 1, 2
• Lower computer screens below eye level and schedule breaks every 20 minutes to increase full blinking 1, 2

Treating Underlying Conditions

• Treat concurrent blepharitis or meibomian gland dysfunction with warm compresses for 5-10 minutes twice daily and gentle lid massage 1, 2
• Failing to address these underlying conditions can exacerbate dry eye regardless of artificial tear use 1, 2

Critical Pitfalls to Avoid

• Do not use preserved artificial tears more than 4 times daily - switch to preservative-free formulations at this frequency 1, 2
• Do not minimize or ignore oral antihistamines - they can significantly exacerbate dry eye symptoms and should be avoided or minimized 1
• Do not fail to recognize when to advance therapy - inadequate treatment of moderate to severe disease occurs when clinicians don't escalate from artificial tears to anti-inflammatory agents 1, 2

Red Flags Requiring Ophthalmology Referral

• Moderate or severe eye pain 2
• Lack of response after 2-4 weeks of optimized therapy 2
• Corneal infiltration or ulceration 2
• Vision loss or visual disturbances 2