Dry Eye: Proper Administration of Artificial Tears

Dry eye is sometimes referred to as “a nuisance complaint — it’s not the sexiest of eye problems.” Nonetheless, said Dr. Rachel Bishop, chief consulting ophthalmologist at the National Eye Institute, “Dry eye disease deserves serious professional — and personal — attention. It can be very debilitating and seriously diminish a person’s quality of life.”^[12]

According to the the Dry Eye Workshop report, prevalence of dry eye ranges from 5–30% in people aged 50 years and older.^[1]

The management of dry eye involves various strategies and therapeutic approaches, which include:

• Find out the underlying cause of the dry eye^[10]
• Select a good and affordable OTC drop^[11]
• This turns out to be very important after some eyedrops made in India were found tainted with a drug-resistant superbug^[18,19]
• Get rid of day eye naturally^[13]

In addition, proper administration of dry eye medications remains vital to a successful treatment.

Preservative-Free Eye Drops

Artificial tear formulations are typically buffered solutions that contain electrolytes, surfactants, and one or more viscosity agents or lubricants, and may or may not also contain a preservative.^[1]

However, for long-term usage of eye drops, you may want to avoid artificial tears using preservatives such as benzalkonium chloride (BAK).  Why?  Based on a recent study conducted at the University of Illinois at Chicago, scientists have found that topical application of BAK to the eye may cause:^[5-7]

1. Corneal neurotoxicity^[7]
2. Inflammation 
3. Reduced aqueous tear production

Recommended Ways of Product Use

In the following discussions, we will focus on two areas:

1. Different forms of artificial tear preparations — liquids, gels, or ointments
2. Preservative or preservative-free drops

For optimizing benefit from ophthalmic medications, here are the recommended way of product usage:

1. General instructions
• If using two different types of eye drops, instill the first, wait 5 minutes, then instill the second.
• If using drops and ointment, instill the drop first, wait 5 minutes, then apply ointment.
• When using products in single-use vials, agitate the container so that the color and/or opaqueness of its contents are uniform. 
2. Preventing contamination
• For patients who need to instill artificial tears several times daily, larger containers of medication are desirable
• British researchers observed that patients who frequently apply eye drops may need to carry multiple single-dose containers, which are cumbersome.^[2] They also recognized that purchasing single-dose containers can be more than 1,000 percent as expensive. 
• If you want to save remaining medication for use beyond the first day, then consider:
• Dry eye medications have been tested and scientists have found that they remained uncontaminated when exposed to room air for as long as 28 days
• However, to reduce the risk of infection to a level with which we are relatively comfortable.  Here are what Dr. Perry and Dr. Donnefeld have advise their patients:^[3]
• Preservative-free artificial tears are free of contamination the day they are opened, are probably not contaminated on the second day, but are likely contaminated on the third day and must be discarded
• Wash hands before opening container
• Prevent container tip from touching the eye
• When finished, tighten container cap
• Single-use vials should be used immediately after opening and discarded after use
3. Eye Drops
• Instilling instructions
• Lean head back. 
• Instill eye drops by gently sliding skin below eyelid over prominent point of cheekbone to form pocket. 
• Put one drop into pocket. 
• Close eye and refrain from blinking for about 1 minute. 
• Press tightly (but not tightly enough to cause injury) with one finger on inside corner of eye for about 30 seconds after instilling drop. 
• Use only 1 drop at a time.
• The eye’s conjunctival fornix can accommodate only 1 drop at a time. Any fluid beyond 1 drop will overflow. 
4. Ointment
• Application instructions
• Start at inside corner of eye
• Squeeze thin line (about 0.5 cm) of medication along inside of lower lid
• Blink
• Artificial tear ointments may offer longer lasting relief but may cause blurred vision and, as such, may work best just before bedtime.

References

1. An Overview on Dry Eye Treatment: Approaches for Cyclosporin A Delivery
2. Eye Health: How to Choose an OTC Drop (Travel to Health)
3. Oldham GB, Andrews V. Control of microbial contamination in unpreserved eyedrops. Br J Ophthalmol. 1996;80:588–591.
4. Issues in the UseOf Preservative-Free Topicals
5. OTC Drops: Telling the Tears Apart
6. Becquet F, Goldschild M, Moldovan MS, et al. Histopathological effects of topical ophthalmic preservatives on rat corneoconjunctival surface. Curr Eye Res. 1998;17:19-25;410–425.
7. Corneal Neurotoxicity Due to Topical Benzalkonium Chloride
8. "Help Improve Your Vision with Simple Exercises" (Dr. Mercola)
9. How to Get Rid of Dry Eyes Naturally
10. How do I soothe dry eye symptoms?
11. Eye Health: How to Choose an OTC Drop (Travel to Health)
12. Dry Eyes Deserve Attention
13. How to Get Rid of Dry Eyes Naturally
14. Five Dry Eye Treatments Unheard of by Most People
15. Optometrist or Ophthalmologist: Which Is Best for Your Eye Care?
• “Optometrists can handle nearly all the medical aspects of ophthalmology. But they do not perform surgery,” Dr. Wagenberg explains.
16. Sjogren's Syndrome (Dr. Weil)
• The most common symptoms are dry eyes or dry mouth.
17. Systemic omega-6 essential fatty acid treatment and pge1 tear content in Sjögren's syndrome patients
• Omega-6 administration increases the PGE1 levels in tears of patients with SS and improves ocular surface signs and symptoms of ocular discomfort.
18. How Eyedrops Contaminated With a Superbug Blinded and Killed Americans (Bloomberg)
• Superbug were found in the over-the-counter eyedrops which were made in India.
• What made the outbreak possible is a gaping hole in the FDA’s supervision of these kinds of medicines.
• Over-the-counter drugs are essentially produced and sold on the honor system.
19. No Testing, No Inspections: Contaminated Eyedrops Blinded and Killed Americans (Bloomberg; 07/17/2023)
• The eyedrops from EzriCare LLC and Delsam Pharma LLC were recalled after the pseudomonas contributed to four deaths, 18 cases of vision loss and scores of infections.