More than ever, people are suffering from dry, irritated, red eyes that may be itchy or have a sandy, gritty, foreign body sensation. Paradoxically, some dry eye patients can actually complain about tearing. They are tearing because the quality of the tears is not good, and the body is producing more to lubricate the eyes. Dry eyes can cause blurry vision, pain, and eye fatigue and redness. Increased screen time reduces the blink reflex, which is necessary to distributes the tears to the ocular surface and expresses the oils into the tear film. Masks are also causing air to flow upward to the eyes and evaporate the tears, exacerbating and causing dry eyes.  

By far, the best over-the-counter drops for dry eyes are Preservative Free Tears. They do not contain any harmful preservative chemicals that can be irritating and make a dry eye worse by breaking up the oil layer of the tears or damaging the goblet cells on the ocular surface. These preservative free products are specifically marked preservative free on the box and either come in individual vials, or more recently, in a specially designed bottle with a cap that filters out bacteria, so the solution does not need to have a preservative in it. They are all safe to use with and without contact lenses. Preservative free tear products are not damaging to the ocular surface and can be used as many times a day as you need them. However, if you are having to use a tear product more than six times a day, it is recommended that you go to an eye care professional for examination. 

The different preservative free products use about four different categories of ingredients. I have seen patients who have had allergic reactions to each of these. The allergic reactions are local, eye irritation and redness. Therefore, it is important to know what is in the product you are using, so you can switch to another category if you have a reaction to one. Often, it is trial and error to a find a product category that is best for you. I have seen patients with allergies to each of these ingredients, and usually when they switch to products that contain other ingredients, they do well. 

These are my favorite products: 

I really like the first produced of the preservative free bottled products, Allergan’s Refresh Relieva preservative free. It contains carboxymethylcellulose and glycerin, which are commonly used, but also contains sodium hyaluronate, which makes it very soothing. Again, Allergan also makes this product in a bottle WITH a preservative. So, it is very important to read the bottle and make sure you have the PF formulation. It is a great all-around dry eye relief product.

Some people prefer preservative free tears in individual use vials, which they find easy to carry and use. There are different products and brands each containing different ingredients. It is important to know which ingredients are in the products you are using, because I have seen patients have allergic reactions to one brand and do fine when switching to another that has different active ingredients. One popular brand is Systane Ultra by Alcon. The active ingredients are Polyethylene Glycol and Propylene Glycol. Other popular brands that use these active ingredients are Johnson and Johnson’s blink preservative free tears, which uses polyethylene glycol and Bausch and Lomb’s Soothe XP, which uses propylene glycol and glycerin. I have seen people who love these brands and people who cannot tolerate them due to allergic reactions. 

In those cases, patients often do well with preservative free tear products that contain other active ingredients such as Allergan’s Refresh Optive, which contains carboxymethylcellulose and glycerin, or Alcon’s Genteal preservative free tears, which contains Dextran and hypromellose or Biontears preservative free tears by Alcon which contains dextran and hydroxypropyl methyl cellulose. 

For patients who have meibomian gland disease as a component of their dry eye, meaning the oil layer of the tears is not produced well, like Rosacea patients, Preservative free tears made with oil are extremely helpful. Refresh Optive Mega-3, by Allergan, has Carboxymethylcellulose and Glycerin as well, but castor oil and flaxseed oil as inactive ingredients. These oils are very helpful for patients who have a poor oil layer.  However, patients can have allergic reactions to these oils, so if your eyes get more irritated with use, most likely it is an allergic reaction, and the product should be stopped.

Another preservative free product that is very good for patients who have meibomian gland disease as a component of their dry eye, which is increasingly being recognized as a majority of dry eye patients, is Ocusoft’s Retaine MGD Preservative free. The active ingredient in this eye drop is mineral oil, which gives it a milky color, but makes it long lasting and soothing for patients. Again, there are people allergic to mineral oil, and if you experience irritation, discontinue and try another product. 

Dry eye can be a serious chronic eye condition that can cause scarring of the cornea, eye infections and even perforation. So, if you have persistent symptoms that are not relieved by preservative free tears alone, or if you have to use the preservative free tears six times or more a day, it is important to get professional help from an eye care professional. You may need prescription treatment.