Eye Drops Explained by an IRIS Optometrist
Several types of eye drops are available on the market, either over-the-counter or available with a prescription. We asked an Optometrist from the IRIS family to tell us more on the subject.
What is your opinion about eye drops? As an Optometrist, would you recommend them to your patients?
Drops can be of several kinds: lubricating (like artificial tears), antibiotics, anti-inflammatory, anti-allergic, or to establish a diagnosis (pupil dilators, dyes, anesthetics), etc. Most of these drops should be prescribed by the Optometrist and can treat a certain condition (glaucoma, inflammation, infection, dryness, etc.) except in the case of lubricating drops, which are over-the-counter and can relieve dry or irritated eyes. These drops can be bought in pharmacies without prescription, but it is usually difficult for patients to really get what they need because there are so many products available, and they are not all equal.
For non-prescription drops, I recommend that my patients pick a product that will reproduce the lipid layer of the tear film as it is often this layer that is missing in dry eye problems. This thin layer of oil on the surface of the tears prevents the evaporation of tears. Without this protective layer, tears evaporate more quickly, creating a sensation of dry eye. Most non-prescription drops do not have this lipid layer and will not be effective as a result. Many drops, usually the oldest and least expensive, will contain Benzalconium Chloride (BAK) as a preservative, and this BAK is known to be toxic to the cornea if it is used too frequently. For these reasons, I recommend drops that do not contain BAK, such as Systane Balance, Systane Complete or Refresh Optive Advanced.
There is also the whole range of drops without preservatives. They usually come in a box containing about fifty small vials to administer single doses (Thera Tears, Refresh Celluvisc, Refresh Enduro). Still, they are generally much more expensive and are not very practical because you have to open and discard small vials after each use.
Optometrists' offices that specialize in the dry eye will sell some even more specialized effective and concentrated drops without preservatives. In these particular cases, I recommend these:
- EyeDrop Pure and EyeDrop PurGel (from I-Med Pharma): without preservatives and comes in a bottle with an anti-bacterial valve that closes the bottle as soon as a drop comes out. Patients will bring the bottle with them without bringing a box of vials everywhere they go. These are viscoadaptive drops containing hyaluronate that provide excellent coverage of the ocular surface and coverage during each blink.
- Hyabak (from Labtician) contains hyaluronate and works similarly.
- Thealoz (from Labtician) contains Trehalose 3%, a natural substance found in many plants and animals that helps them survive in extreme drought conditions. Trehalose has properties that protect and stabilize the cell membrane of the corneal epithelium (the surface layer of the eye).
- Thealoz-Duo (from Labtician) combines Trehalose to protect the cell membrane with hyaluronic acid to lubricate the eye.
Who can benefit from the use of eye drops?
Just about everyone can benefit from the use of non-preservative eye drops. Age is the most important risk factor in dry eye, usually because the body is no longer able to recreate the protective lipid layer on the surface of the tears, so they will evaporate more quickly. Also, all situations that force us to fix an object, such as driving, reading, watching TV, knitting, etc., will help make our eyes dry. The more our eyes fix something, the less we blink, and the more their surface has time to dry. I, therefore, recommend to my patients who have symptoms, such as burning eyes, the feeling of having sand in their eyes, watery eyes or if the vision becomes confused after a few minutes of reading, to put these drops in 3 to 4 times daily, or as needed.
What about the eye drops that reduce the redness of the eyes? Do they really work?
Like Visine or Clear Eyes, these drops contain a vaso-constrictor agent that will shrink the blood vessels in the area, thus increasing the effect of the whiteness of the eye. But in fact, these drops only hide the underlying problem. In addition, the prolonged use of these vasoconstricting drops will create the rebound effect where the blood vessels, after several cycles of constriction-dilation, will become more flexible and larger. The human body will react, and to counteract the vaso-constrictor effect, the vessels will become larger, and the eye will look redder and redder permanently. A little like when you play with an elastic too long, it loses its elasticity and becomes larger, and there comes a time when it will shrink more. I have already had several patients who used Visine drops every day for five years and still had red eyes. By stopping Visine drops and adopting a good treatment, it took almost a year before their eyes started to be normal again.
Can certain types of drops be dangerous for the eyes?
Most drops are not dangerous. Preservatives of lower quality (BAK) can create a long-term allergic reaction. Steroidal anti-inflammatory drugs, used for inflammation of the eye, may, if long-term drops are used, increase intraocular pressure and cause glaucoma and cataracts. Still, these drops are only available on prescription, and Optometrist will do the necessary follow-ups to verify that you do not have these side effects.
Would you recommend a brand of eye drops in particular?
I recommend drops without preservatives, in general:
- For light dry eye: Pure I-Drop or Hyabak
- For moderate to severe dry eye: I-Drop PurGel or Thealoz, or Thealoz-Duo
Otherwise, if the patient wants to go to an over-the-counter pharmacy: Systane Complete and Refresh Optive Advanced are the two that I recommend.
About Dr. Nanini
How long have you been in the IRIS family?
I have been with the IRIS buying group since 2000 and my office joined the IRIS banner in 2009 when the network was expanded in Ontario.
What is your hometown?
I was born in the beautiful city of Quebec!
What makes you proud to be an optometrist?
Being able to help people every day. To be able to heal them, to allow them to see better and to make sure that they have an excellent quality of view for the rest of their lives.
What do you like most about your job?
The contact with my patients. I love being able to follow patients every year since they are small until they’re grown-ups. I love educating my patients about their conditions and what to do to maintain good vision and eye health.
What sets IRIS apart from other optical banners?
IRIS is committed to providing the highest quality products and services in the world of optics. So, it's very rewarding to be associated with ''high quality'' rather than ''low price''. I know that at IRIS, my patients will only be offered high quality products with the ultimate goal of giving them the experience of better vision.