From the Guidelines
For patients struggling with dry eye, I recommend starting with preservative-free artificial tears such as Refresh, Systane Ultra, or TheraTears, as they are well-tolerated and cost-effective, and should be used 4-6 times daily for mild to moderate dry eye, as suggested by the most recent evidence 1.
Key Considerations
- The use of preservative-free hyaluronates drops is recommended, with formulations having higher hyaluronate percentage considered to offer greater therapeutic efficacy for more severe disease 1.
- Thicker formulations like Systane Gel Drops or Refresh Celluvisc can provide longer-lasting lubrication but may temporarily blur vision, and are suitable for more severe cases.
- Nighttime ointments such as Refresh P.M. or GenTeal Severe Gel can be applied before sleep for overnight protection.
Additional Recommendations
- If artificial tears at this frequency don't provide adequate relief after 2-3 weeks, prescription options like cyclosporine (Restasis) or lifitegrast (Xiidra) may be necessary, as they work by reducing inflammation on the ocular surface and increasing tear production 1.
- Patients should avoid drops with preservatives like benzalkonium chloride if used frequently, as these can irritate the eye with long-term use.
- Using a humidifier, taking omega-3 supplements, and practicing the 20-20-20 rule during screen time (looking 20 feet away for 20 seconds every 20 minutes) can complement the effectiveness of lubricating eye drops.
Important Notes
- Dry eye syndrome can compromise results of cataract, corneal, and keratorefractive surgery, and patients with dry eye syndrome considering these surgeries should be cautioned that the dry eye symptoms could become worse after surgery 1.
- Baseline ocular surface and tear film parameters predict the patients at risk, and all patients undergoing lens-based surgery should be evaluated and managed for dry eye preoperatively and postoperatively 1.
From the FDA Drug Label
INDICATIONS AND USAGE RESTASIS® ophthalmic emulsion is indicated to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. The recommended lubricant eye drops for a patient who struggles with dry eye is RESTASIS® ophthalmic emulsion, as it is indicated to increase tear production in patients with keratoconjunctivitis sicca 2, 2.
- Key points:
- Increase tear production in patients with keratoconjunctivitis sicca
- Not recommended for patients taking topical anti-inflammatory drugs or using punctal plugs Note that RESTASIS® contains cyclosporine, an immunosuppressive agent.
From the Research
Lubricant Eye Drops for Dry Eye
- The choice of lubricant eye drops for a patient with dry eye can be based on several factors, including the severity of symptoms and the presence of other ocular conditions 3, 4, 5, 6, 7.
- Studies have shown that preservative-free artificial tears containing carboxymethylcellulose (CMC) and hyaluronic acid (HA) can be effective in improving symptoms and signs of dry eye 3.
- Other options include artificial tears containing sodium hyaluronate and trehalose, which have been shown to improve dry eye signs and symptoms and increase patient satisfaction 5.
- A comparison of different artificial tear formulations found that sodium hyaluronate-based lubricants provided better relief for patients with moderate dry eye disease 6.
- In terms of cost-effectiveness, a study found that Systane (a lubricant eye drop) was more effective than Refresh Tears in improving symptoms of dryness, but at a higher cost 7.
Key Considerations
- The Ocular Surface Disease Index (OSDI) score can be used to assess the severity of dry eye symptoms and monitor response to treatment 3, 4, 5.
- Non-invasive tear break-up time (NIBUT) and tear meniscus height can be used to evaluate the effectiveness of artificial tears in improving tear film stability 6.
- Patient satisfaction and preference should also be taken into account when selecting a lubricant eye drop 4, 5, 6.