What are artificial tears and why are they used?

Artificial tears are lubricants manufactured to simulate the normal tears that coat your eyes.  They come in many different preparations.  They are used by people who have dry eyes due to insufficient tear film from a variety of causes including lid problems, auto-immune disease (like Sjogren’s syndrome), and ageing. 

What are the main types of artificial tears?

Depending on the underlying cause of the dry eye, different types of artificial tears are recommended.  For example, evaporative dry eye is a condition in which the natural oils are missing from the normal tears (usually due to blepharitis).  The lack of oil allows the tears to quickly evaporate from the surface of the eye, leaving it dry.  Therefore, some artificial tears include oils to prevent evaporation.  Examples of artificial tears with oils include Soothe XP, Systane Balance, Refresh Optive and Refresh Digital.

Another cause of dry eye is aqueous deficiency.  That is, the tear glands do not produce enough water to coat the eye. This may be caused by ageing or auto-immune disease.  In this case, hypotonic tears help.  They are labelled, “hypotonic” or “hypo-osmolar.”

Many people have a combination of problems that cause their dry eye, and a combination of artificial tears may help.  Examples of good basic artificial tears include Soothe, Blink, Refresh, and Systane.

Preservatives or no preservatives?

Artificial tears come both with and without preservatives.  Preservatives are used to keep the bottle free of contamination allowing for a prolonged expiration date.  Unfortunately, some people are sensitive to preservatives, especially if drops are required more than 4-times-a-day for comfort.  Therefore, preservative-free tears are made to improve comfort (at the price of a shorter expiration date).  Examples of tears with preservatives includes Systane and Blink Tears.  If there are no preservatives in a preparation of artificial tears, the box is usually labelled clearly.

Why do some artificial tears last longer than others?

Artificial tears come in varying degrees of viscosity or thickness.  The thicker the tears, the longer they last.  However, thicker preparations may blur the vision for several minutes.  The thickest preparations include gels (e.g.  Genteal Gel) and ointments (e.g. Lacrilube Ointment and Sooth Nighttime).  They may be best used at night before sleeping as they coat the eye overnight, making the eyes feel better upon awakening. 

What more can be done for dry eyes?

If artificial tears do not give relief from dry eye symptoms, there are a variety of options.  In patients with evaporative dry eye, flaxseed oil or fish oil supplements by mouth may improve the tear film after a month or so.  Similarly, warm compresses may improve the teat film.  Punctal plugs may be used to block the outflow of tears from the eye.  And prescription eye drops (Restasis and Xiidra) may be helpful to treat aqueous deficiency.  If blepharitis contributes to the dry eye, tea tree oil preparations may also help.   

By Scott E. Pautler, MD 

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