Artificial tears are generally the FIRST thing patients with dry eye reach for. In my dry eye clinic, artificial tears have usually been tried before coming in. But do they even help? In today’s blog I’ll go over artificial tears and whether or not they’re helping your dry eyes.
Welcome back to the Eye school blog, with me Dr. D, where I teach you about products and treatments related to dry eye syndrome and eye beauty so you can have healthy, beautiful, comfortable eyes. When you’re treating dry eyes it’s important to use a combination of different therapies in order to improve quality of life and symptoms and generally improve your patients condition.
While I have newer interventional treatments that I tend to favor over the older treatments like artificial tears, it’s still important to recognize the situation in which artificial tears really can help a patient. So what exactly are artificial tears? Artificial tears are eye drops that are used to lubricate dry eyes and help maintain moisture on the outer surface of your eyes. This type of eye drops may be used to treat dry eyes that result from aging, certain medications, a medical condition, eye surgery or environmental factors, such as smoky or windy conditions.
“Although artificial tears are used to mimic or supplement the roles of the tear film and contain water, electrolytes, and certain polymers, they do not contain the biologically active components found in naturally-produced tears. Artificial tears often contain chemicals that are not present in naturally-produced tears. Preparations can contain carboxymethyl cellulose, polyvinyl alcohol, hydroxypropyl methylcellulose (a.k.a. HPMC or hypromellose), hydroxypropyl cellulose and hyaluronic acid (a.k.a. hyaluronan, HA).” (source)
In this blog we will dig deeper into how artificial tears can be helpful and intp the ways in which they definitely are not.
Here is How Artificial Tears Can Help Your Eyes
QOL Benefit- first let’s talk about quality of life. The truth is, artificial tears just feel good. I’ve heard it said that putting in an artificial tear is kind of like using a breath minute. It feels really good on your eyes. It makes them feel wonderful but after about 10 minutes or so that dryness and irritation is going to come back.
Now in a breath mint they’re gonna make your breath really fresh and nice but again after about 10 minutes your stinky breath is gonna be back that’s exactly what it’s like with artificial tears. However there is no denying that using artificial tears can be very helpful for situational tasks like being on a computer for a long period. We all know that throwing in an artificial tear can be just what you need to revitalize those tears and make your eyes feel more comfortable and your vision better.
Optical Quality - Next, let’s discuss optical quality. It’s no secret that it’s critical to have a healthy tear film in order to see well. For instance, in a clinic when patients are being refracted [which means that they’re getting their glasses prescription checked] some patients will note that their vision changes - one option might seem clear and then the alternate option seems clear and if you blink it seems to clear your vision up.
And clinically, this is one of the most obvious signs that my patients are suffering from a fluctuating tear film. If you experience visions that fluctuate like I just described then artificial tears may be very helpful in order to give you that nice, clear refracting surface that’s gonna make your vision and your optical quality more consistent.
About What Artificial Tears Can’t Do For Your Eyes
Artificial tears, although helpful in many circumstances, cannot do it all. Notably they are unable to help with ocular inflammation, reducing meibomian gland obstruction, or killing Demodex mites.
Decrease inflammation - Ocular surface inflammation is present in virtually every type of dry eye disease from every cause of Dry Eye. Artificial tears are unable to help with ocular surface inflammation. Furthermore, by altering the tear chemistry and artificially putting more aqueous in the tear film it is possible that they could worsen Dry Eye inflammation. In order to treat ocular information from Dry Eye disease doctors use a combination of anti-inflammatories like steroids as well as immunomodulators like cyclosporine and Lifitegrast. .
Reduce obstruction - 86% of Dry Eye disease has a meibomian gland dysfunction component. Therefore reducing gland obstruction is absolutely critical in treating Dry Eye‘s long term. Unfortunately artificial tears do absolutely nothing to clear gland obstruction.
The only treatments we have that help with gland obstruction include utilizing heat on the eyelids paired with expression to clear the glands. Currently there are no artificial tears that impact the glands in this way, and therefore artificial tears are pretty much useless when it comes to meibomian gland dysfunction.
Kill demodex mites - finally, artificial tears are ineffective at killing Demodex mites on the eyelid. Demodex mite infestation is quite common especially as we get older and results in changes in meibomian gland secretions, eyelid irritation and the symptoms of dry eye disease. Treating Demadex usually requires several strategies but things like Teatree oil and intense pulsed light has been proven effective in killing Demadex mites and reducing their overpopulation on the lids. Unfortunately again this is an area where artificial tears simply do not help.
Artificial Tears Should Be Included In Your Dry Eye Regimen
Undoubtedly artificial tears will be a piece of your dry eye treatment regimen. That’s completely normal, and I recommend artificial tears for nearly all of my patients. However it’s important to understand what they’re good at and what they’re not good at so that you have reasonable expectations of where they fit in your daily Dry Eye routine.
Remember they can be wonderful for making your eyes feel better as well as see better in a very short term setting. However, you must consider how you’re going to get your inflammation under control, how you’re going to clear gland obstruction, and how you’re going to deal with the overpopulation of Demodex mites if that is an issue for you.
Make sure to let me know down below your experience with artificial tears. Tell me your favorites, ones you can’t stand, and those you’d like to try.
Review of AFT’s https://www.mdpi.com/1422-0067/23/5/2434
Optical Quality https://link.springer.com/article/10.1186/s12886-022-02280-7
2022 Update https://jamanetwork.com/journals/jama/article-abstract/2788545?casa_token=ddyVHQeS-XgAAAAA:I2k6QSZZtmIEbvnmGIlvdhUwv01QF_oLYKiJGZoBjDILGGah-rPsHQNKpiPr012Ezp8ihsMU9A