Best Artificial Tears for Your Eyes
Many patients have a love/hate relationship with artificial tears, especially if they are contact lens wearers or post-LASIK or other refractive surgery patients.
If feel your eyes during the day or have any discomfort when you blink, know that this is not normal and your eye is crying out for help. You should not feel your eyes at all during the day or when you blink. If you do, it can mean your tear film is not working as it should. Many patients have become so used to having discomfort for the majority of the day, that they have begun to ignore their eyes. This can have devastating consequences. If you feel your eyes frequently in terms of pain or irritation, it means there is some inflammation happening at some cell level in your eye. Left alone, it can lead to scar tissue. We see the scar tissue in different parts of the eye under the microscope during exams frequently. Scar tissue can form on the cornea and in some patient lead to a loss of vision that requires surgery for removal. Scar tissue can form in the meibomian glands and lead to meibomian gland dysfunction and chronic eye pain. Scar tissue can also occur at the goblet cells but this is harder for us to see with current technology.
Each TEAR has 3 components:
Lipid: from Meibomian Gland: makes the tear stick & stay on surface
Aqueous: from Lacrimal Gland
Mucin: from Mucin cells on conjunctiva
If one of these components is missing, then the tear will not work and you will feel discomfort.
If you have tried step 1 & 2 on the step ladder in a previous post (step 1 & 2 are lid hygiene with warm compresses 2-3x/day and gently scrubbing closed eyelids with diluted Tea Tree Oil or Avenova once or twice a day; increased Omega 3 intake to 2000-4000mg), and your eyes are still dry, then yes, you do need artificial tears.
The trick is finding the one that is right for your eyes given your particular circumstances (ie, do you wear contact lenses, your profession, your eye health history, etc).
Some of the drops are thinner and may need to be applied more often; some drops & ointments are thicker: they will last longer but might blur your vision or make your eyes feel “icky.” They might be better for you just at night time or before a nap.
Sometimes it takes trial and error to see which one is right for your eyes, and that is ok. Your eyes will bounce back even from an allergic reaction to a preservative, which can happen.
Preservative free are the best, but they are more expensive:
-Know that you can use the non preserved tear vial (they come in these small tubes) for the whole day or more if needed:
1. With clean hands, open the top and place on a clean tissue or clean towel to avoid contaminating the tip.
2. You can thus use that vial till it runs out assuming the tip does not get contaminated with a bacteria (ie, dirty hands). There is a theoretical risk of bacterial contamination, but I have never seen an infection from one; the risk is likely very small.
Tears with preservatives also work well and can be used without fear in most patients. Some patients are sensitive to preservatives (you may not know till you try; if you get itching, redness after such a drop, you are likely allergic). Preserved tears should not be used more than 4 times per day for this reason: to avoid a reaction to the preservative which can be toxic to the cornea if over used. Using preserved artificial tears four times a day does not harm the cornea in the vast majority of patients.
My favorite artificial tears for my patients (contact lens wearers or not) are the following (I have no financial interest in any of the below companies:)
Remember that if you get sick of using artificial tears, there are other options that might make economical sense long term (though we are starting a head to head comparison of IPL, LF, IDP, and artificial tears: which works the best? Know one knows for sure yet!).
1. Preservative Free of any drop is best: of the Preservative Free Options:
1) Retaine MGD
2) Refresh Plus
3) Oasis
4) Systane
5) Thera Tears single vial preservative free (PF)
6) Bio Tears
7) Generic Brands work well on some patients as well
2. Of the Preserved Tears:
1) Refresh
2) Tears Naturale
3) Systane Brand
4) Gen Teal
5) Hypotears
6) Bausch & Lomb Advanced Eye Relief
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Revised below from good site: Dry Eye Zone by non-medical person. PRODUCT: New:Retaine MGD nonpreserved: contains: Novasorb™, a proprietary cationic oil emulsion technology (microemulsification) that effectively delivers ingredients through the electrostatic attraction between positively charged droplets and the negatively charged ocular surface.The hypotonicity of the emulsion adds moisture by lowering the salt concentration of tears while the lipid component lubricates and protects the surface of the eye. It is especially helpful in conditions associated with Meibomian Gland Dysfunction. LIST: |
ACTIVE INGREDIENT(S) Novasorb |
PRESERVATIVE None |
| Advanced Eye Relief “Environmental” | 1.0% Glycerin | BAK !!! |
| Advanced Eye Relief “Rejuvenation” | 0.3% Glycerin 1.0% Propylene glycol |
BAK !!! |
| Advanced Eye Relief Night Time (fmrly. Moisture Eyes PM) | White petrolatum, mineral oil | None (PF) |
| 0.3% HPMC, 0.1% Dextran 70 | None (PF) | |
| Blink (R) | Polyethylene glycol 400 0.25%. Also has sodium hyaluronate. | Sodium chlorate |
| Clarymist | Soy lecithin 1.0% | Phenoxyethanol 0.5% |
| Freshkote (2) | 2.7% blended PVAs, 2% povidone | Polexitonium |
| Genteal Mild | 0.2% HPMC | GenAqua |
| Genteal Moderate to Severe | 0.3% HPMC, 0.25% CMC | GenAqua |
| Genteal Gel | 0.3% HPMC, Carbopol 980 | GenAqua |
| Genteal PM | White petrolatum, mineral oil | None (PF) |
| Hypotears | 1.0% PVA, 1.0% polyethylene glycol | BAK !!! but also comes in unpreserved unit dose |
| Lacrilube | White petrolatum, mineral oil | Chlorobutanol |
| Lacrisert | ||
| Moisture Eyes | See “Advanced Eye Relief” | |
| Nature’s Tears Eye Mist | None | |
| Quintess Qusome eyelid spray | TBA | TBA |
| Oasis Tears | 0.2% glycerin (15%) | None (PF) |
| Oasis Tears Plus | 0.2% glycerin (30%) | None (PF) |
| Optive Lubricant Eye Drops | 0.5% CMC, 0.9% glycerin | Purite ? |
| Refresh Lubricant Eye Drops | 1.6% PVA, 0.4% povidone | None (PF) |
| Puralube ointment | 85% petrolatum, 15% mineral oil | |
| Refresh Tears | 0.5% CMC | Purite |
| Refresh Plus | 0.5% CMC | None (PF) |
| Refresh Celluvisc | 1.0% CMC | None (PF) |
| Refresh Endura | Glycerin 1.0%, polysorbate 80 1.0% | None (PF) |
| Refresh Liquigel | 1.0% CMC | Purite |
| Refresh PM | White petrolatum, mineral oil | None (PF) |
| Similasan | HOMEOPATHIC mercurius sublimatus 6x, belladonna 6x, euphrasia 6x |
silver sulfate |
| Soothe | Glycerin (0.6%), propylene glycol (0.6%) | None (PF) |
| Soothe XP (“Extra Protection”) | Light mineral oil (1%), mineral oil (4.5%) | Polyhexamethylene Biguanide |
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Soothe Xtra Hydration (new 2010)
SUBJECT TO RECALL! CLICK HERE FOR DETAILS
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Glycerin (0.55%), propylene glycol (0.55%) | Butylated hydroxyanisole |
| Systane | 0.4% Polyethylene Glycol 400, 0.3% Polyethylene Glycol | Polyquad |
| Systane | 0.4% Polyethylene Glycol 400, 0.3% Polyethylene Glycol | None (PF) |
| Systane Free
SUBJECT TO RECALL! PLEASE CLICK HERE for details.
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0.4% Polyethylene Glycol 400, 0.3% Polyethylene Glycol | “preservative free in the eye” |
| Tears Again liposome spray | TBA | TBA |
| Tears Naturale Forte | 0.3% HPMC, 0.1% Dextran 70, 0.2% glycerin | Polyquad |
| Tears Naturale II | 0.3% HPMC, 0.1% Dextran 70 | Polyquad |
| Tears Naturale Free | 0.3% HPMC, 0.1% Dextran 70 | None (PF) |
| Tears Naturale PM | White petrolatum, mineral oil | None (PF) |
| Thera Tears | 0.25% CMC | Sodium perborate |
| Thera Tears single-use vials | 0.25% CMC | None (PF) |
| Thera Tears Liquigel | 1.0% CMC | None (PF) |
| Visine Tears | 0.2% HPMC, 0.2% glycerin, 1% polyethylene glycol 400 | BAK |
| Visine Pure Tears Portables | 0.2% HPMC, 0.2% glycerin, 1% polyethylene glycol 400 | None (PF) |
| Visine Pure Tears Single Drop Dispenser | 0.2% HPMC, 0.2% glycerin, 1% polyethylene glycol 400 | |
| Viva Drops | Polysorbate-80 (1%) | None |
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| 0.3% HPMC, 0.1% Dextran 70 | None (PF) | |
| Genteal Mild | 0.2% HPMC | GenAqua |
| Genteal Moderate to Severel | 0.3% HPMC, 0.25% CMC | GenAqua |
| Optive | 0.5% CMC 0.9% Glycerin |
Purite ? |
| Refresh Tears | 0.5% CMC | Purite |
| Refresh Plus | 0.5% CMC | None (PF) |
| Refresh Celluvisc | 1.0% CMC | None (PF) |
| Refresh Endura | Glycerin 1.0%, polysorbate 80 1.0% | None (PF) |
| Refresh Liquigel | 1.0% CMC | Purite |
| Tears Naturale Forte | 0.3% HPMC, 0.1% Dextran 70, 0.2% glycerin | Polyquad |
| Tears Naturale II | 0.3% HPMC, 0.1% Dextran 70 | Polyquad |
| Tears Naturale Free | 0.3% HPMC, 0.1% Dextran 70 | None (PF) |
| Thera Tears | 0.25% CMC | Sodium perborate |
| Thera Tears single-use vials | 0.25% CMC | None (PF) |
| Thera Tears Liquigel | 1.0% CMC | None (PF) |
| Visine Tears | 0.2% HPMC, 0.2% glycerin, 1% polyethylene glycol 400 | BAK !! |
| Visine Pure Tears Portables | 0.2% HPMC, 0.2% glycerin, 1% polyethylene glycol 400 | None (PF) |
| Visine Pure Tears Single Drop Dispenser | 0.2% HPMC, 0.2% glycerin, 1% polyethylene glycol 400 | |
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| Note: “Advanced Eye Relief” is the B&L product line formerly known as MoistureEyes | ||
| Advanced Eye Relief “Environmental” | 1.0% Propylene glycol, 0.3% glycerin | BAK !!! |
| Advanced Eye Relief “Rejuvenation” | 0.95% propylene glycol | BAK !!! |
| Advanced Eye Relief “Rejuvenation” | 0.95% propylene glycol | None (PF) |
| Oasis Tears | 0.2% glycerin (15%) | None (PF) |
| Oasis Tears Plus | 0.2% glycerin (30%) | None (PF) |
| Optive | 0.5% CMC 0.9% Glycerin |
Purite ? |
| Systane | 0.4% Polyethylene Glycol 400, 0.3% Polyethylene Glycol | Polyquad |
| Blink | Polyethylene glycol 400 0.25%. Also has sodium hyaluronate. | Sodium chlorate |
| Systane | 0.4% Polyethylene Glycol 400, 0.3% Polyethylene Glycol | None (PF) |
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| Dwelle (1) | 2.7% blended PVAs, 2% povidone | Polexitonium |
| Dakrina (1) | 2.7% blended PVAs, 2% povidone | Polexitonium |
| Freshkote (2) | 2.7% blended PVAs, 2% povidone | Polexitonium |
| Hypotears | 1% Polyvinyl Alcohol , 1% Polyethylene Glycol 400 | BAK !!! But also available PF |
| NutraTear (1) | 0.4% PVA (99% hydrolyzed), 0.2% PVA (87% hydrolyzed) | Polexitonium |
| Refresh Lubricant Eye Drops | 1.6% PVA, 0.4% povidone | None (PF) |
| NutraTear (1) | 0.4% PVA (99% hydrolyzed), 0.2% PVA (87% hydrolyzed) | Polexitonium |
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| Soothe | Light mineral oil, mineral oil | Polyhexamethylene Biguanide |
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| Similasan | HOMEOPATHIC mercurius sublimatus 6x, belladonna 6x, euphrasia 6x |
silver sulfate |
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| Genteal Gel | 0.3% HPMC, Carbopol 980 | GenAqua |
| Refresh liquigel | 1.0% CMC | Purite |
| Systane Free SUBJECT TO RECALL! PLEASE CLICK HERE for details. |
0.4% Polyethylene Glycol 400, 0.3% Polyethylene Glycol | “preservative free in the eye” |
| TheraTears liquid gel | 1.0% CMC | None (PF) |
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EDITOR’S NOTE: At The Dry Eye Zone we are not fond of ointments and recommend caution in any long-term use of them. Think of the tear film as a delivery vehicle for important nutrients to the entire cornea and conjunctiva. Grease applied directly to those surfaces is going to interfere with tears reaching them, so our concern (bear in mind this is coming from laypeople not medical professionals) is that while helping to temporarily protect the cornea it may be making it more vulnerable. In our community forums we get frequent reports of worsening of symptoms with long-term use of ointments. So please discuss with your doctor other options too. Check out our night dry eye page for suggestions about other ways to protect eyes at night.
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| Advanced Eye Relief Night Time (fmrly. Moisture Eyes PM) | White petrolatum, mineral oil | None (PF) |
| Genteal PM | White petrolatum, mineral oil | None (PF) |
| Lacrilube | White petrolatum, mineral oil | Chlorobutanol |
| Puralube | White petrolatum, mineral oil | |
| Refresh PM | White petrolatum, mineral oil | None (PF) |
| Tears Naturale PM | White petrolatum, mineral oil | None (PF) |
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| Clarymist (UK) | Soy lecithin 1.0% | Phenoxyethanol 0.5% |
| Nature’s Tears | None | |
| Quintess Qusome eyelid spray | TBA. (NOTE: As far as we know, this is NOT a liposome spray but some other kind of eyelid spray.) | TBA |
| Tears Again liposome spray | Like/equivalent to the Clarymist liposome spray | |
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| PRODUCT | ACTIVE INGREDIENT(S) | PRESERVATIVE |
| FreshKote | 2.7% blended PVAs, 2% povidone | Polexitonium |
| Lacrisert | n/a | |