Updated: Feb 6, 2023
When suffering from dry eye syndrome or having red, irritated eyes, many people reach for lubricating eye drops. Let's not assume that all eye drops work the same because they simply don't. Many different ingredients are utilized for eye drops, which can make it hard to find the ideal eye drops that work for your dry eyes. Have you ever walked down the aisle in a pharmacy or health store and looked at all the available brands, leaving you scratching your head on which one to pick?
So how are you supposed to know which eye drops are the best, how their ingredients work, and whether a product might or might not work for you? First of all, eye drops for dry eyes are not all made the same. Did you know that they are specifically designed and formulated to treat different types of dry eye syndrome? There are three major types of dry eye.
The first is called aqueous deficient dry eye, which is when the eye doesn't produce and provide enough water to their tear film. A common reason is a hormonal imbalance or certain autoimmune conditions such as Sjogren's syndrome.
The second type is called evaporative dry eye, which is more common than the aqueous deficient dry eye condition. It usually occurs when the interaction of oil glands (called the meibomian glands) and eyelids aren't fully functioning. This results in degraded tear film stability and eventually leads to the tear film evaporating into the air.
Last but not least, the third type is called mixed dry eye. It is a combination of the two above - the aqueous deficient and the evaporative dry eye. Studies have shown that around 80-90% of dry eye symptoms can be classified as mixed dry eye.
So, how does this impact your search for the best dry eye drops? Well, e.g. if you are using eye drops that are specifically designed for aqueous deficient dry eyes, when in fact you have more of the evaporative form of dry eye, then it's just not going to work as well as you'd expect.
Before you read any further, we always recommend you make an appointment with your eye care practitioner so he/she can evaluate your dry eye condition and help you understand what is going on and which products can help.
With that, let's go over the best eye drops for dry eyes that are available for each of the three types of dry eye.
Eye Drops for Mixed Dry Eye
Systane Complete
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As most patients have some form of mixed dry eye, one of our favorite picks is Systane Complete from Alcon Inc. Introduced in 2018, this product contains 0.6% propylene glycol, an active ingredient known to evenly spread across the eye. Propylene glycol plus an oil-based lubricant help to protect the mucous membranes of the eye by coating your eye surface layer allowing your eyelids to easily glide over your eyes. At the same time, this combination supplements the oils that are not being produced by the eyelids. As a result, it balances your tear film so that it doesn't evaporate as quickly. Systane Complete also comes with Nano-Droplet technology, which helps make the active ingredients much smaller. This helps to spread the ingredients over the entire surface of the eye, creating a high-density matrix of active molecules. The result is a smooth coat for complete protection.
Refresh Digital PF
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Another favorite for mixed dry eye is Refresh Digital PF - developed and manufactured by AbbVie Inc. Refresh Digital is contains a unique combination of ingredients such as carboxymethylcellulose glycerin, polysorbate, and castor oil. Together they cover the surface of the eye, improve viscosity, and protect the mucous membranes of the eye. So when you're blinking, you have a smooth coating that prevents the tears from evaporating from the surface. Refresh Digital is also available as Refresh Digital PF with a preservative-free fomulation packaged in individual vials.
Eye Drops for Evaporative Dry Eye
Now outside of the mixed form of dry eye, the next most common dry eye type the evaporative dry eye. Again, this is your tear film is not stable because the glands don't produce enough lubrication hence the tear film evaporates too fast.
Refresh Optive Mega-3
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One of our favorite picks for patients who have this type of dry eye is REFRESH OPTIVE MEGA-3. REFRESH OPTIVE MEGA-3 not only contains castor oil to help stabilize the tear film but it also contains flaxseed oil. So you have two different oil bases to help stop those tears from evaporating. The preservative-free product also contains an ingredient called trehalose. Trehalose is a glucose-based substance that has been found to help stabilize cell membranes on the surface of the eye and prevent osmolarity or salt concentration changes. These occur as your tears evaporate and leave the salt in those tears behind and that can cause damage to the eye surface which can therefore lead to more dryness and other symptoms such as blurred vision.
Other products are Systane Balance, Soothe XP from Bausch+Lomb as well as Retaine MGD from OCuSOFT. All of these are fitting into that evaporative dry eye class.
Eye Drops for Aqueous Deficient Dry Eye
If you're somebody with aqueous deficient dry eye either because you have Sjogren's Syndrome or you had Lasik eye surgery and your cornea isn't sending the signals to your brain to make more tears consider products containing hyaluronate.
Systane Hydration PF
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Systane Hydration PF contains a naturally occurring ingredient called sodium hyaluronate which acts to make the eye drop stick better to the surface of the eye. So the drop is not just hitting the eye and sliding and draining out. Instead, it's sticking to the eye surface which can be very comforting. However, you might have to blink a few times after putting them in and you can tell that it's just a little bit gluey on your eyes.
Refresh Relieva PF
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Another product we like is Refresh Relieva PF. It contains two lubricants. Carboxymethylcellulose sodium (0.5%) and glycerin (0.9%) are embedded in a preservative-free formula. Similar to other preservative-free products, you can buy Refresh Relieva either in a patented multidose mini-bottle or in a box containing 30 individual vails (Refresh Relieva PF). Refresh Relieva PF is recommended for sensitive eyes and - after discussing with your eye doctor - can be used after LASIK or other eye surgeries.
How to save money
One way to save money is by checking out our price comparison pages. Visit a product in our product hub section. We compare prices from popular retailers that sell eye drops online. One other way you can save money with your eye drops is using a product called NanoDropper. NanoDropper is a new tool that screws on to most standard eye drop products. It changes the size of the droplet that's coming out. So instead of this large eye drop, that often dribbles down the side of the eye causing you to waste much of that drop, it makes it much smaller so you're getting just the right amount you need onto the eye without changing the effectiveness of that drop. And because you're using fewer drops you're basically extending the life of your eye drops by about 50-60%. You can check out NanoDropper here.
Some thoughts about preservative-free formulations
Most of the eye drop products that you'll find out there are usually preserved with special ingredients. One of these ingredients is benzalkonium chloride (BAK) which is very potent. However, it can cause some issues with the eye surface and it is known to cause nerve damage. It is also known to delay wound healing and it can even cause a toxic reaction at the surface of the eye. So if you're using eye drops with benzalkonium chloride over and over throughout the day and for a longer period of time, it could cause more irritation and damage to the eye than help you. By the way: the eye drop products mentioned in this article do not contain BAK and - instead - either contain PolyQuad, OcuPure, or some other preservatives which are known to not cause so much irritation to the surface of the eye. Still, many eye doctors will recommend patients to look for preservative-free eye drops and you can often find them in small little plastic tubes (called vails) that have a twist-off cap. After using multiple drops you can discard it and open a new, fresh tube as required.
Final Words
Always be aware of what you're putting in your eye, check with your eye doctor if not sure, and avoid over-the-counter products or generic eye drops containing benzalkonium chloride. If possible, choose preservative-free drops to avoid any additional chemicals in your drops. Feel free to submit a comment on which one of these eye drops you have tried and had the most success with or if you've used other types of eye drops and had great success with.