August 2019


Artificial tears playbook for dry eye

by Vanessa Caceres EyeWorld Contributing Writer

eyeComfort box
Source: ReVision LASIK and Cataract Surgery


Artificial tears are often the first line of defense for dry eye. Because they are so ubiquitous in eyecare, ophthalmologists and optometrists must regularly evaluate what’s new to the artificial tears market and what tear-use practices are most effective for patients.
Although some patients already use artificial tears, they may decide to visit their eye doctor because the drops don’t seem to be enough. They may think they need to try a different kind of tear or treatment. Some may realize the value of getting to the root cause of their dry eye.
“There are a number of reasons that patients can experience dry eye, including problems with the eyelids and systemic conditions,” said Lisa Park, MD. “It is important to treat these underlying causes in addition to using artificial tears to address symptoms of dry eyes.”

Product choice

Though some eye doctors may have strong artificial tear preferences, many think the majority work well.
Ming Wang, MD, tends to recommend tears when he has samples available for patients. With the easy availability of Refresh (Allergan) and Systane (Alcon)—along with related coupons he can pass on to patients—he tends to recommend those tears to patients. “Systane Balance, Systane Ultra, Refresh Plus, and Refresh Optive are typically my top recommendations in [those] families,” he said. “Other good brands include Soothe [Bausch + Lomb], Blink [Johnson & Johnson Vision], and TheraTears [Akorn],” he said. A newer tear called Refresh Repair (Allergan) provides symptomatic relief but also helps heal the surface of the eye, he said.
Preservative-free tears have many fans. “Preservative-free artificial tears are recommended, but for maximum coating of the ocular surface, I have been leaning toward gel drops or Refresh Celluvisc,” said Mark Nolan, OD.
Rebecca Petris has an online dry eye store and is in daily contact with dry eye patients. She advises customers to steer clear of generic brands that still contain benzalkonium chloride. “The safest rule of thumb is to purchase preservative-free lubricant drops,” she said. Newer preservative-free multidose bottles can help economize the costs of preservative-free tears, Ms. Petris said.
At ReVision LASIK and Cataract Surgery, doctors give patients their eyeComfort box, which contains a 60-day supply of products they have found work well for dry eye. The box contains Oasis artificial tears (Oasis Medical), Retaine Flax (OCuSOFT), HypoChlor Spray (OCuSOFT), and a Bruder Moist Heat Eye Compress (Bruder Healthcare Company).
“At the end of the 60-day supply, the patient’s progress is evaluated. If the patient is getting relief and symptoms are effectively managed, they can choose to replenish the eyeComfort box supplies for another 60 days and continue on with that treatment plan,” Dr. Nolan said.
Although cost can be a concern with any treatment, tears are a less pricey option than prescription medication, said Nathan Rock, OD. He advises patients to not go for the cheapest generic option, which may use an older and less effective formulation.
One final recommendation: Dr. Park sometimes must educate patients about the difference between tears and a product like Restasis (cyclosporine, Allergan). She explains to patients that “[Restasis] does not work instantaneously as a tear replacement and needs to be used on a regular basis to achieve its effect.”

Tear instructions

Instructions on how often to use drops usually depends on symptom severity, said James Schumer, MD. He recommends using drops for burning sensations or blurred vision. However, if no symptoms are present, there’s no need to use the drops.
Dr. Rock will advise that patients use tears once or twice daily for mild symptoms. For more advanced cases, he recommends tear use four times a day. “Be sure to be diligent about the use of tears and to use them preventatively, rather than waiting for symptoms to occur when they will then be less effective,” he said.
Dr. Rock cautions patients against using more than one drop at the same time. This, he said, can lead to waste.
Eye drops of any kind can be hard to administer, so Dr. Schumer shares specific guidance with patients.
Patients with trouble getting artificial tears into their eyes may want to try the Simply Touch applicator (Simply Touch USA), Ms. Petris said. “It can be quite helpful both with the process and with reducing [drop] loss,” she said.

When to go stronger

If patients are using tears four times a day or more, that may indicate the need for a stronger treatment, Dr. Wang said. Treatment options at that point may include prescription medications, punctal occlusion, in-office treatments, oral supplements, and lifestyle modifications.
Another option is a more viscous drop when artificial tears do not coat well or do not alleviate symptoms, Dr. Schumer said.

About the sources

Mark Nolan, OD

ReVision LASIK and
Cataract Surgery
Columbus, Ohio

Lisa Park, MD
Associate professor
Department of Ophthalmology
Columbia University
Medical Center
New York

Rebecca Petris
Dry Eye Company
Poulsbo, Washington

Nathan Rock, OD
Wang Vision 3D Cataract and
LASIK Center
Nashville, Tennessee

James Schumer, MD
ReVision LASIK and
Cataract Surgery
Columbus, Ohio

Ming Wang, MD
Wang Vision 3D Cataract and
LASIK Center
Nashville, Tennessee

Contact information


Patient instructions

Pearls for better tear use
•Pull the lower lid out and put the drop in behind the eyelid.
•Lay down flat to ensure the drop gets into the eye.
•Aim for the inner corner of the eye.
•Allow for the shape of the orbit bones to act as a natural funnel to get the drop into the eye.

Source: James Schumer, MD

Financial interests

Nolan: None
Park: None
Petris: None
Rock: None
Schumer: None
Wang: None

Artificial tears playbook for dry eye Artificial tears playbook for dry eye
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