The eyes have it

Do you suffer from chronically dry, red, itchy eyes? The eye drops you use might actually be making your eyes look and feel worse.

Like so many over-the-counter (OTC) products, there are dozens of eye drops from which to choose. How do you know which is best?

As always, ignore the front of the package and read the ingredients.

Oxymetazoline HCl and naphazoline HCl are decongestants. Drops that advertise “decreased redness”, such as Visine, contain a decongestant that constricts the small blood vessels in the eye. It works temporarily, but has a “rebound” effect; that is, the redness gets worse after the decongestant wears off.

Ketotifen and pheniramine are antihistamines. These drugs control the eye itchiness that accompanies an allergy, such as hay fever.

Glycerin, polyethylene glycol and propylene glycol are lubricants. Once or more of these will be the primary ingredient(s) in “soothing” or moisturizing eye drops.

These drugs might also be found in combination with each other. Only buy what you need.

More importantly, find what is listed as the preservative. All multi-use eye drops must include a preservative to prevent bacterial growth, and it is the preservatives in eye drops that cause the most problems.

Benzalkonium chloride (BAK) is the most common preservative. Because it is also the cheapest, it is usually found in less expensive brands, such as Visine.

In the medical journal Progress in Retinal and Eye Research, the authors state that

…the most frequently used preservative, benzalkonium chloride (BAK), has consistently demonstrated its toxic effects in laboratory, experimental  and clinical studies… Care should therefore be taken to avoid long-term use of preservatives.

More expensive brands, such as GenTeal and Systane, claim to have less irritating preservatives, but if your eyes are sensitive and you use the product frequently, any preservative can result in inflammation.

It’s easy to get stuck in a cycle of using drops more often, which increases eye irritation, which then causes you to use more drops, and so on. Eventually, you might find yourself at the ophthalmologist’s office getting a prescription for Restasis (cyclosporine), which costs about $150 for a 30-day supply! And it doesn’t always work.

The single-use, preservative-free eye drops cost a bit more than the multi-use, but I find I only need to use them once or twice a week to keep my eyes feeling comfortable. Although the package says single use, there is enough solution in each vial for one drop in each eye, two or three times a day. My ophthalmologist says this is fine as long as the drops are used within a day.

So, if your eyes are chronically dry and irritated, despite using eye drops and ointments every day, try switching to preservative free and see if that, finally, “gets the red out.”

Sláinte!

Frugal Nurse

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