As a cornea specialist, I have noticed the number of patients I am seeing for dry eyes has dramatically increased over the past few years. Whether it's the air quality or the increased reliance on oral medications to treat other conditions that dry your eyes out as a side effect, nobody seems to know. But numerous studies have shown that the prevalence of this condition is definitely on the rise. So, if your eyes are feeling dry, burning or scratchy, what are your options to help relieve your symptoms?
The "go to" treatment for dry eyes has always been and continues to be, Artificial Tears. What has changed over the last few years is the huge variety of artificial tear preparations available. There is no "best" artificial tear for everyone. Some people love one brand and others hate it. Unfortunately, finding the best artificial tear for you is generally a "trial and error" process. However, here are a few guidelines. One big distinction between Tear preparations is the preservative in them. Generally, the generic store brand Tears will contain older, less expensive but more toxic preservatives and therefore probably are not the best thing for an inflamed dry eye cornea. You should try and stay away from these. Preservative free Tears are the best but they are significantly more expensive, mainly due to the increased packaging costs involved. My general rule of thumb is to use the "Rule of 4" when deciding when it is worth paying extra for preservative free. If you are using Tears less than 4 times a day, you are probably ok using a Tear that contains preservatives. More than that, go the no preservative route. Most of the newer, brand name Tears have preservatives in them that are significantly less toxic than in years past. Some of them even have preservatives in them that are designed to be neutralized once they are dropped on the eye.
The next big decision to make concerns the viscosity of the drop. One of the biggest problems with treating dry eyes with Tears is that they make your eye feel better but it is only a temporary respite. Obviously, the thicker the drop, the longer it remains on the eye and consequently, the longer the beneficial effect. However, the downside to this is that the thicker the drop, the more it blurs your vision. The thickest artificial tear preparation is an ointment, such as Lacrilube or even better, Refresh PM which also has the benefit of being preservative free. However, ointments usually blur your vision for several minutes. Therefore, ointments usually should be reserved for using just before going to sleep. The next best thing is a gel. I am a big believer in Genteal Gel. It is thicker than a tear but less viscous than an ointment and generally only blurs your vision for 30 to 60 seconds. Several companies now offer a "Gel-Drop" which lasts longer than a regular Tear drop but only blurs you for maybe 5 seconds in most cases.
The tear film consists of an aqueous layer and above it an oil layer(called lipid). The purpose of the lipid layer is to prevent evaporation of your tears. In some cases, the cause of your dry eye is that you have excessive evaporation due to a poor or lacking oil layer. There are now some artificial tear preparations such as Systane Balance specifically designed to increase your lipid layer and thereby diminish evaporation of your natural tears. Unfortunately you probably won't be able to tell yourself if this is the cause of your dry eyes but your Marietta Eye Clinic doctor should usually be able to and make a recommendation for this type of Artificial Tear if he thinks it would be the most beneficial for you.
With these guidelines in mind, next time you go see one of our doctors, ask for samples of the many different brands/types of Artificial Tears. We usually have plenty of samples and are happy to give them to you. Try them all and see which works best for you. In my next blog, I will discuss what your options are for treating dry eyes if Artificial Tears just are not giving you enough relief. Good luck!
-Steven Corwin, MD