#173: Myth #2 All Eye Drops are the Same

Nov 09, 2022

We are talking about three myths about dry eye disease. This blog is dedicated to Myth #2: "All dry eye drops are the same." New patients come in to see me all the time and say, "I've tried everything out there." This basically means that they went to the drugstore, and they picked up Visine and one other generic artificial tear. They tell me they tried them both. Their eyes felt great for about five minutes, but returned to the same level of dryness right away.

Even when talking about products that you can buy at the drugstore, not all dry eye drops are the same. There are 3 types of over-the-counter (OTC) products.

#1) Artificial Tears

In fact, even the ones that you get over the counter are different. You can go to the drugstore and buy artificial tears. If they come in a bottle, they have preservatives in them. If you use them more than four times a day, you're polluting your eyes with toxic chemicals called preservatives.

Artificial tears need to be preservative free. Preservative-free drops like Systane Complete PF, which stands for preservative-free, are packaged in foil pouches. Inside the foil pouch, there are individual vials. The vials keep the tears free of bacteria.

There's just a small amount of tears in each of these vials. After you've popped the top you can throw the vial away.

#2) Gel Drops

Beyond drops, there are also gels or gel forming drops. Gels generally come in some kind of a bottle or a vial. They are thicker than an artificial tear, which means they'll last a little bit longer on your eyes. This keeps your eyes feeling moist longer.

#3) Ointments

Finally, there are also dry eye ointments. These are packaged in tubes that are usually labeled as PM, bedtime, or nighttime. And it comes out thicker like Vaseline. To use the ointment, start with a clean finger. Squeeze a small amount on to the tips of your finger, then roll the ointment into your lower lid.

Those are what are available over the counter drops, preservative, free drops, gels, and appointments. If you'd like to find out which kind would work best for your eyes, please download the Ultimate Guide to Artificial Tears here. It will walk you through choosing the best drops for your lifestyle. Also, if you think you need more than one kind of tear, check out this blog on Combining Artificial Tears.

Prescription Dry Eye Medications

When you go to your eye doctor, you can get a prescription for dry eye medication. And there are currently three categories of dry eye medications on the market.

#1) Immunomodulators

The first type it's called immunomodulators. These are used long term to decrease the inflammation inside the eyes. In time, the tears are more healthy and the dryness heals. They all come as a preservative-free solution in small vials. There are 3 drugs in this category:

Restasis (2003) cyclosporine 0.05% solution
Xiidra (2016) lifitegrast 5% solution
Cequa (2019) cyclosporine 0.05% solution

#2) Steroids

The second category is steroid eye drops. Steroids reduce inflammation quickly. Steroid drops all come as a bottled drop. Currently, there is only one steroid drop that is FDA approved for the treatment of dry eye flares. It's called Eysuvis.

If you have dry eyes, you know that sometimes your eye dry eyes feel good. And, sometimes they feel bad. Typically a dry eye patient has a dry eye flare 2 - 6 times a year. That is when Eysuvis would come into play. When you're experiencing a dry eye flare, you can use Eysuvis up to four times a day for two weeks.

If you'd like to learn more about how Eysuvis works, check out this blog.

#3) Neurostimulation

The final category of prescription dry eye treatment medication is a nasal spray. It's called Tyrvaya, a neuro stimulator. This product has been a game changer for people who hate putting drops in their eyes or have trouble putting drops in their eyes because their hands shake.

Tyrvaya stimulates the trigeminal nerve, which connects the brain to the eye. In the eye, the nerve branches to three parts, all of which stimulate tear production, before it continues down the nose to the end of your nostril.

When using Tyrvaya, spray it into the side of the nostril so that the tip points towards your eye. This acts to stimulate the trigeminal nerve. And, within seconds you actually feel a tear inside your eye. I love it. It helps increase tear film homeostasis, which keeps your eye moist and stable. Watch a video about Tyrvaya here.

CONCLUSION

Not all dry eye drops are the same. You have both OTC and prescription drops to choose from. In the OTC category, there are different options based on the thickness of the drops: tears, gels, and ointments. If you would like a guide to help you choose the best artificial tear for your eyes, download the Ultimate Guide to Artificial tears here.

Prescriptions medications also come in three categories. There are immunomodulators, steroids, and neurostimulators. Often, dry eye sufferers need a prescription medication to calm down the inflammation inside the eye, produce more tears, or to produce healthier tears. Your eye doctor can determine which one is best for you.

If you would like to get started on developing a Dry Eye Relief plan to get your eyes to feel normal again. Watch this video to learn how.