Chronic dry eye is a disease of the surface of the eye that can happen when your eye does not make enough tears or there is an issue with the tears that are made. Chronic dry eye may also be called dry eye, dry eye syndrome (DES), dry eye disease (DED), or keratoconjunctivitis sicca.1
Chronic dry eye is not always easy to treat. Finding the underlying cause of dry eye symptoms may be difficult. However, there are different treatment options available. One treatment choice for chronic dry eye is a group of eye drops called ocular surface lubricants, also commonly referred to as artificial tears.
How do ocular surface lubricants work?
The ocular surface, or the surface of the eye, is unlike other wet-surfaced tissue in the body. This is because the surface of the eye is exposed to the outside world.2
The smooth, wet surface of the cornea helps to focus light through the lens and onto the retina for vision.2
The ocular surface also protects and smooths the outer layer of the eye, allowing for clear vision and ease of blinking. The ocular surface includes various tissues, glands, and moisture, including the tears, tear glands, and the outer tissues of the eye.2
Ocular surface lubricants work to replace the same components found in your tears to relieve symptoms of dry eye, such as:3
- Stinging
- Burning
- Itching
- Redness
- Blurred vision
Formulations
Ocular surface lubricants are available as liquid solutions, gels, or ointments. Most of these types of drugs are available without a prescription as over-the-counter (OTC) products. It may take several brands or types to find which one works best for you.
Liquid tears tend to provide the quickest relief and smooth over the ocular surface without blurring vision. However, liquid tears only last a short amount of time, sometimes just under 30 minutes before reapplication is needed.3
Gel tears are thicker and provide longer-lasting symptom relief without significantly blurring vision.3
Ointments are the thickest and can provide lubrication to the surface for many hours. Ointments tend to blur the vision significantly. Some people find that it is helpful to use these before bedtime. A gel or ointment form of lubricating eye drops may be needed if you have more severe dry eye symptoms.3
There are many brands of ocular surface lubricants. A few of these include:4-8
- Liquid tears, such as Systane® and Blink®
- Gels and ointments, such as Genteal Tears Lubricant Eye Gel®, Genteal Tears Severe Eye Ointment®, and Refresh PM Eye Ointment®
- Tear insert Lacrisert® (hydroxypropyl cellulose ophthalmic insert), which is a 24-hour lubricant available by prescription only
What are the possible side effects?
In general, ocular surface lubricants are well tolerated with few side effects. Rare side effects may include:9
- Burning
- Redness
- Irritation
- Allergic reaction/conjunctivitis
Some OTC eye drops have preservatives, such as benzalkonium chloride (BAK), to prevent the growth of bacteria. BAK is the most commonly used preservative in eye drops. BAK has been shown to cause further inflammation and irritation to the surface of the eye in certain people. It is best to avoid eye drops with added preservatives if using more than four times per day, if possible.10
Anti-redness drops, such as Visine, have additives that work by constricting (narrowing) the blood vessels in the eye. These drops may lead to rebound redness after the eye drop wears off and can lead to worsening redness over time. These eye drops are not recommended by eye specialists and should not be used for those with chronic dry eye.10
These are not all the possible side effects of ocular surface lubricants. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with ocular surface lubricants.
Additional treatment options
Along with ocular surface lubricants, there are other treatments available for the signs and symptoms of chronic dry eye. Some of these include:11
- Immune modulating eye drops
- Regenerative eye drops
- Short-term drugs
- Various devices and procedures, including those to improve tear production
- Complementary and alternative medicine
If you have used several lubricating drops and are still suffering from dry eye symptoms, it is time to talk to your eye doctor. Chronic dry eye can be severe and impair many aspects of your daily life. Your doctor will examine your eyes, ask you questions about the symptoms you are having, and work with you to find the best treatment.
Before beginning treatment for chronic dry eye, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.
