Eye drops for dry eyes crowd the shelves of pharmacies and bamboozle us with claims of symptomatic relief. Dry eyes are one of the most common reasons to use eye drops but are we choosing the best drop for the job?
Dr Jim Kokkinakis is one of Australia’s most prominent dry eye experts and offers the following tips on choosing eye drops for dry eyes:
The best eye drops for dry eyes may only be available on prescription
At The Eye Practice dry eye clinic, Dr Jim Kokkinakis sees many patients with severe dry eye. They have often been to several practitioners before they arrive in his consultation room.
‘Their eyes are so sore and inflamed that I often put them straight onto anti-inflammatory eye drops for several weeks to bring the inflammation under control immediately. This not only improves comfort, but critically, it calms down any inflammation so that other therapies can be effectively used to treat the debilitating condition,’ he says.
It is incredible what is available without a prescription these days. A pharmacist can hand you a bottle of Chlorsig which, 9 times out of 10, will do more harm than good, in the context of dry eyes.
Chlorsig is an antibiotic, which is great against bacterial infections. Most red and irritated eyes though are NOT infections, so this eye drop has no role to play.
Even worse are decongestant drops for red eyes, such as Murine and Visine.
These drops constrict the delicate network of blood vessels in the eye, resulting in a temporary reduction of redness.
Unfortunately they do nothing to treat the underlying cause of the redness and in fact can make it worse.
Regular use of these drops can cause rebound inflammation (which flares up as soon as you try to stop using them) resulting in addiction for many users.
Prescription Eye Drops for Dry Eyes
Globally the eye drop that has been most successfully financially for pharmaceutical companies is called Restasis®. It is an anti-inflammatory called cyclosporine mixed with a proprietary oily emulsion. In our experience it has not been all that successful, yet the sales keep going.
Luckily the Australian government has had some great advice about Restasis®, and has blocked its prescription without a government authority. The concentration of Restasis is 0.05% and anecdotally we have been prescribing compounded cyclosporine up to 1%. The weakest concentration we will prescribe is 0.2%
This is between 4 to 20 times stronger! The good news about compounded cyclosporine is that it is virtually free of side effects, so is a reasonable eye drop to use for dry eyes that have a significant inflammation component.
Any eye drop with a preservative may make your condition worse
Most eye drops that come in a bottle are preserved, either with benzalkonium chloride (a biocidal agent that is toxic to living tissue) or a milder preservative such as Purite, which degrades on exposure to light.
This is all well and good but…
There is no substitute for preservative-free when it comes to treating dry eyes and to this end, we prescribe specially compounded eye drops that are free from any preservatives.
There are some over-the-counter preparations that come in unit-dose or one-way valve delivery systems and are genuinely preservative free.
Not all dry eye treatment drops are created equal
Many eye drops for dry eyes are simply artificial tears, replacing the moisture lost through evaporation from our eyes’ surface.
While these can be useful in certain situations (such as replacing moisture lost during a long-haul flight) they are often best reserved for temporary use as they do nothing to address the underlying cause of dry eye.
Some formulations though contain additional ingredients, such as hyaluronic acid, which is the lubricant that occurs naturally in joints.
In cases where several brands of eye drops have failed to provide symptomatic relief, drops like Hylo Forte, which are delivered via a one-way valve (so no preservative!) can reduce symptoms of grittiness and dryness.
Sometimes the best eye drops for dry eyes are no drops at all
What! How can that be?
Jim requests that his patients cease the use of all eye drops the day before their first consultation with him. This is so that he can accurately diagnose their condition but it also surprisingly results in more comfortable eyes – sometimes for the first time in years.
This may be to do with preservatives but also to do with the action of the drops of flushing out your own natural tears. ‘The best advice I give my patients is not to put anything into your eyes unless advised by a therapeutically endorsed optometrist (or an ophthalmologist).
GPs just don’t have the diagnostic equipment in their practices to adequately magnify and illuminate your eye for an accurate diagnosis.
Pharmacists can tell you about the drug but not about your own eyes and are therefore not in the best position to recommend an eye drop for you’, says Jim.