How to Choose the Best Eye Drops for Dry Eyes, According to Eye Doctors

Not all eye drops are created equal—here's what to look for to find the most relief.

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Anyone who's ever dealt with dry eye—a common condition in which your eye don't produce enough tears, or enough quality tears—knows they're more than just a minor annoyance: the scratchy, gritty sensation; the light sensitivity; the blurred vision—it's a decidedly unpleasant experience.

The good news? Many folks with dry eyes can find relief from eye drops, but it's often not an easy decision. To help you navigate the dozens of solutions available, we've tapped three optometrists to share their tips on how to choose the best kind of eye drops for your dry eyes—including what you need to know about prescription vs. over-the-counter (OTC) eye drops, and eye drops that contain preservatives compared to ones that don't.


What to know about using eye drops for dry eyes

Eye drops are one of the most popular and effective OTC medications used today, William T. Reynolds, OD, president of the American Optometric Association, tells Health. For many people, they can be a good option for managing dry eye—in fact, they're usually the first line of defense for combatting dry eye symptoms.

That said, improperly using or overusing drops can sometimes worsen eye conditions, says Dr. Reynolds. That's why it's important to follow the safety instructions as directed by the packaging or an eye doctor.

It's also worth noting that the type of eye drop that's right for you will depend on the severity and cause of your dry eye (severe dry eye, for example, might need prescription eye drops, while more mild or moderate cases may benefit from OTC drops). That's why, if you have dry eye, it's best to discuss your options with an eye doctor for a more personalized recommendation, over heading to the drug store to pick your own.

While the type of eye drop you'll need is based on your own specific needs, there is one type of eye drop that experts recommend everyone with dry eyes steer clear of: eye drops that promise to clear up red eyes. These drops (think: Visine or Clear Eyes) constrict the blood the blood vessels in your eyes so that they appear white, Tom Cruse, OD, optometrist with Insight Vision Group in Denver and site residency director for the Illinois College of Optometry, tells Health. But they're not very effective at treating dry eyes—and if the blood vessels are constricted for too long (which can happen when these products are used regularly) you can get "rebound redness," he adds.

OTC eye drops vs. prescription eye drops

OTC eye drops

There are two broad categories of eye drops for dry eyes: OTC eye drops and prescription eye drops. If you have mild to moderate dry eyes, your doctor will likely recommend OTC drops to start. This is the easiest and most economical choice, Arti Shah, OD, fellow of the American Academy of Optometry and optometrist at Elander Eye Care in Santa Monica, tells Health. But there's a catch: With more than 35 different brands of OTC eye drops, "they're not all created equal," she warns.

For many patients, Dr. Shah typically recommends lipid-based moisturizing drops as a first option. These drops can bolster the outer lipid or oily layer of your tear film (this layer helps prevent evaporation of the eye's protective tear film), and help support the watery or aqueous layer. But this is also where a more personalized recommendation comes in handy: If your dry eye is caused by a problem with the sticky or mucous layer of the tear film (the layer that essentially helps tears stick to the eye), then you may find more relief from a different type of eye drop.

People with more severe dry eyes may need to use a lubricating ointment or gel, which you can also buy OTC. These options, which are thicker than regular drops and stay in your eyes longer, may blur your vision temporarily, so most people use them just before bedtime, says Dr. Reynolds.

While Dr. Shah still recommends that everyone talk directly with their eye doctors to find the eye drops that will work best for their specific type of dry eye, she says some of her favorite options for both eye drops and lubricating ointments or gels include:

Prescription eye drops

Some folks with moderate to severe dry eye may do better with a prescription eye drop that is ordered by their doctor. There are currently three major prescription eye drops on the market for dry eyes: Restasis, Cequa, and Xiidra. Restasis and Cequa help you produce more of your own natural tears, whereas Xiidra minimizes inflammation, says Dr. Shah.

The drawback to these prescription medications? You have to keep using them; otherwise, your dry eye will come back. Also, they can take time—think: weeks or even months—before you notice a difference. For faster relief, doctors sometimes prescribe steroid eye drops, Dr. Shah adds. These can quickly assuage irritated, inflamed eyes, but they are not a medication you would use long-term.

For moderate to severe cases of dry eye, doctors may prescribe biologic eye drops, which help tamp down inflammation. For severe dry eyes, they sometimes recommend autologous serum eye drops, which are created using your blood. "You're basically using our own body to heal your own body," explains Dr. Shah.

Eye drops with preservatives vs. preservative-free eye drops

Eye drops with preservatives

Eye drops typically come in two formulations: those with preservatives and those without. "Eye drops with preservatives have chemicals that are designed to keep bacteria from growing in the bottles once they are opened," explains Dr. Reynolds. Preventing bacteria growth is, of course, a good thing. But on the flip side, these preservatives can actually cause dryness and exacerbate irritation in some people. Many eye doctors recommend using eye drops with preservatives no more than four times a day, says Dr. Reynolds.

Preservative-free eye drops

Preservative-free eye drops, on the other hand, have fewer additives and are usually recommended for people with moderate to severe dry eye, says Dr. Reynolds. They are often best for people who use artificial tears more than four times a day, he adds.

How can you tell which kind you're buying? "In general, if it comes in a bottle, it's preserved," says Dr. Shah. About 90 percent of bottled eye drops have preservatives, she estimates. Most preservative-free eye drops come in single-use, tear-off capsules, but there are a few manufacturers who offer preservative-free drops in the convenience of a bottle, including Clear Eyes for Dry Eyes.

Overall, the best eye drops for dry eyes really depend on the severity of your dry eye and what's causing it—that's why it's always a good idea to chat with your eye doctor. With their help, you can find the best treatment option for your dry eyes.

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