Your drops might be making things worse
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 (the marketing claims) 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. Don’t use these drops unless you are suffering from an allergy.
Related post: Home remedies for allergy eyes
Glycerin, polyethylene glycol and propylene glycol are lubricants. One 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.
Save money and find relief from dry eyes
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.
What are some simple and effective ways to treat dry eyes?
- Try the single-use, preservative-free eye drops. They 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.
- Consider using a humidifier in your home. Dry air, especially common in the winter months, increases the dry, scratchy feel of your eyes.
- Stay hydrated and remember to drink several glasses of water every day.
- Increase the omega-3 fatty acids in your diet. Small clinical trials have shown omega-3 supplements decrease dry eye symptoms. I always prefer foods to supplements; foods rich in omega-3s are salmon, sardines, flax seeds, walnuts, canola oil, and soybeans.
- Use cool compresses on your eyes. Try a couple slices of cold cucumber, or refrigerate your used tea bags. You can try a warm, moist washcloth, too.
- Pay attention to eye irritants in the environment. I can’t walk into a Bed, Bath & Beyond without my eyes becoming inflamed! Hair and skin products often contain eye-irritating fragrances or essential oils. Perfumes and dryer sheets can also irritate and dry out your eyes. Find and eliminate as many as you can.
- Cut down screen time. Staring at a computer screen for hours every day makes dry eyes worse. Follow the 20-20-20 rule: for every 20 minutes screen time, take a 20 second break and focus on an item 20 feet away.
- Be aware of any drugs that might make dry eyes worse. Common over-the-counter drugs include antihistamines (Benadryl, Claritin); decongestants (Sudafed PE, Dristan)and some antacids (Zantac, Tagamet). Common prescription drugs include beta blockers, diuretics, antidepressants and estrogen.
Avoid high-priced prescriptions like Restasis
Dry eyes are a normal part of aging. Like wrinkles and gray hair. However, the maker of Restasis—Allergan—would like you to think dry eyes is a disease that can only be effectively treated with their high-priced drops.
How expensive are they? About $250 for one month. And that price is more than double what it was just two years ago. There’s a reason Allergan received a “Shkreli” award from the Lown Institute this year for “egregious examples of profit-mongering in health care.”
Two physicians, Lisa Schwartz and Steve Woloshin, frequently write articles about evidence-based medicine in an effort to shine a light on overuse and overspending.
They recently wrote about the evidence (or lack of) for Restatis, pointing out that the FDA approved Restasis with only “scant evidence of efficacy.” Yet it’s still earns Allergan over $1 billion a year!
As part of their campaign to increase awareness and provide independent information about prescription drugs, Schwartz and Woloshin developed Informulary, a website that provides patients with easy-to-understand Drug Fact Boxes.
What does their Drug Fact Box say about Restasis?
The FDA only approved Restasis because of improved eye wetness tests – not more symptom relief or less artificial tear use
The FDA initially rejected Restasis because it (and an FDA Advisory Committee) felt that the clinical trials did not prove that the drug helped people with dry eyes feel better. The FDA approved the drug – based on the same clinical trials – because a new analysis showed that more people on Restasis (compared to Placebo) had enough wetness on a paper strip put in their eye: 15% vs 5% of people. Artificial tear use was almost the same: 4.1 times a day with Restasis vs 4.6 times a day with Placebo. Since Restasis is used twice a day, people will be using more total drops a day. The trials did not prove to the FDA that people felt their dry eye symptoms were better.
I’m getting older and my eyes are getting drier. Just like I have to take more care with other parts of my body, I have to pay more attention to my eyes to keep them healthy and comfortable.
And I don’t have to go broke doing it.