Can Artificial Tears Be Used in Infants Under 1 Year Old?
Yes, artificial tears can be safely used in babies under 1 year old, but preservative-free formulations are strongly recommended, particularly when frequent application (more than 4 times daily) is needed. 1
Key Safety Considerations for Infants
Preservative-Free Formulations Are Essential
The American Academy of Ophthalmology specifically recommends preservative-free artificial tears for children under 5 years old because preservatives can cause ocular surface toxicity and additional irritation in this vulnerable population 1
Preserved artificial tears may only be sufficient for mild symptoms with infrequent use (less than 4 times daily) in patients with an otherwise healthy ocular surface, but this guidance applies primarily to adults, not infants 1
Preservative-free formulations substantially reduce iatrogenic effects of these frequently applied medications, which is particularly important in infants who may require multiple daily applications 2
Practical Application Guidelines
For any infant under 1 year requiring artificial tears, prescribe preservative-free single-dose units or multi-dose preservative-free bottles 1
If cost or access creates a barrier and preserved tears must be used temporarily, strictly limit use to no more than 4 times daily and monitor closely for signs of toxicity including redness, increased irritation, or punctate keratitis 1
Refrigerated preservative-free artificial tears can be used to dilute allergens and inflammatory mediators on the ocular surface while providing additional soothing relief 1
Contamination Risk Management
While preservative-free artificial tears in reclosable containers carry a 2% risk of bacterial contamination with daily multiple use, this risk is primarily associated with poor administration technique, fingertip touch, and advanced age—factors less relevant in caregiver-administered infant care 3
Ensure caregivers use proper administration technique, avoiding contact between the bottle tip and the infant's eye or surrounding tissues 3
Single-dose preservative-free units eliminate contamination risk entirely and are the safest option for infants 1, 4
Common Pitfalls to Avoid
Never use preserved artificial tears containing benzalkonium chloride or thimerosal in infants, as these preservatives have demonstrated higher toxicity profiles 5
Avoid indiscriminate or prolonged use without medical supervision, particularly if symptoms persist or worsen 1
Do not assume all "preservative-free" products are equally safe—verify the formulation contains appropriate lubricants such as methylcellulose or hyaluronate 6