Choosing Artificial Tears

The artificial tears shelf at a pharmacy is long and confusing. The differences that matter are few: whether the drop has a preservative, how thick it is, and when you use it. Answer the questions below to see what to look for.

This is general guidance, not a prescription. The brands shown are examples; store brands with the same description work the same way. If your doctor has recommended a particular drop, use that one.

The kinds, in plain terms

• Standard artificial tears come in an ordinary bottle with a preservative that keeps the bottle sterile. They are fine up to about four times a day.
• Preservative-free tears come in single-use vials or in bottles with a special tip. Choose them if you need tears more than four times a day, wear contact lenses, have sensitive eyes, or already use other eye drops every day. The preservative itself can irritate the surface with frequent use.
• Gel drops are thicker. They last longer and blur vision for a minute or two, so they suit bad days and evenings.
• Ointment is the thickest. It is for bedtime, because it blurs vision until it is blinked away.
• Tears with oil in them, often labelled "lipid" or "for evaporative dry eye", help when the oil glands in the eyelids are blocked.

Getting the most from them

• Use them on a schedule. Three or four times a day, every day, works better than waiting until the eyes hurt.
• One drop is enough. The eye cannot hold more.
• Leave five minutes between different drops, and put tears in last if you also use prescription drops, unless you are told otherwise. Ointment always goes in last.
• Single-use vials are meant to be thrown away after use. Do not keep an open vial for the next day.
• Do not let the tip touch the eye, lids or fingers.
• Avoid "get the red out" drops. They shrink blood vessels and do not treat dryness, and the redness often comes back worse.

Technique is on Using Eye Drops, and all of these are pictured in the Eye Medication Reference.

When tears are not enough

If you need tears more than six times a day, or they have not helped after a few weeks, it is time to be seen. Treating Dry Eye covers the next steps, including lid care, prescription drops and punctal plugs.