Tired of using drops?

How many occasions have you walked into your local pharmacy only to be overwhelmed by the abundant choice of eye drops. Most drops promising to relieve your burny, scratchy red or itchy eyes. The choice can be overwhelming when you are faced with all these options.

So how do you know which drop is for you? Are some drops more effective than others?

Unfortunately some drops are far superior to others. A simple example of this is your typical “red eye” or “whitening” drops. Decongestant eye drops, or whitening eye drops, contain ingredients that eliminate red eyes by shrinking the tiny blood vessels on the white part of your eyes, making them less visible. Although decongestant eye drops are effective at getting rid of redness, it pays to be aware that they can disguise a potentially grim underlying problem. What may seem like a great temporary fix may actually be more harmful in the long term with excessive use. Hence, numerous over the counter drops readily available can give temporary relief without addressing the underlying cause of ocular discomfort.

Before discussing the different types of tears it helps to understand the anatomy of the human tear film. The best way to think of the tear film is by breaking it up into 3 distinct layers. Each layer being produced by a different part of the eye and has its own important role to play. The bottom layer of the tear film is a mucous layer. The middle “meat in the sandwich” layer of the tear film is the thickest of all and known as the aqueous layer. Followed by the top lipid layer of the tear film. It is not uncommon to have a problem in 1 or more layers of the tear film. With advanced equipment it is now possible to identify which layer of the tear film is problematic and hence target further treatment or drop use appropriately.

The most common type of dry eye disease is caused by issues with the top lipid layer of the tear film. This layer comes from glands on the top and bottom of the eyelids, called Meibomian glands. Ideally we would like to see this lipid come out effortlessly like olive oil upon blinking. However, in individuals with Meibomian gland dysfunction we see thickening of the lipid or even lose the ability to express lipid at all. This leads to what we call evaporative dry eye i.e. loss of the blanket layer of the tear film. MGD can be a result of a range of causes: environmental, genetic, traumatic, age related and even certain medications e.g. Roaccutane. While there are lipid based drops that can alleviate some symptoms, drops alone will not improve this sort of dry eye. Further treatment is recommended by a dry eye specialist.

There are two main categories of artificial tears: preservative and preservative free .The large proportion of bottled drops on the market contain preservatives. The downside of using preservative based drops comes with ocular irritation side effects with use of more than 4-5 times a day.  Preservative free drops are the gold standard if you require use of drops more than 4 times per day. These drops come in vials/minims and also specially designed multi use bottles.

Gels or ointments are another category of “drops’ on the market. These are typically more viscious and can result in temporary blurring of your vision. Typically these are used over night due to their increased time of action on the ocular surface.

Ultimately, there is a huge variety of drops available on the market. A key point is ensuring a proper eye examination is performed in order to correctly diagnose the use or need for eye drops. Most importantly also to ensure your current drops are not masking a potentially progressive condition.