Why Are There So Many Eye Drops?

There has been a lot of discussion in the news recently about eye drop recalls. As a patient, it can be confusing to see an overwhelming amount of choices when looking at the eye drop section of the store. Each drop has its own purpose, but some manufacturers like to complicate the matter. Here is a summary of the different types of drops that we are prescribing and recommending on a daily basis.

Please do not mistake this blog as a way to medically treat your own symptoms. Call our office to schedule an appointment, so we can develop a personalized diagnosis and treatment plan that will work for you.

Artificial Tears

These are the most popular over-the-counter (OTC) drops that are recommended in our office. Dry eye syndrome affects more people now than ever, thanks to the drastic increase in digital device usage. Artificial tears come in several varieties: original, preservative-free, and gel. Original, or regular, artificial tears work for most people, however, preservative-free tears are recommended for those with sensitive eyes or if the drops are going to be used more than four times per day. The preservatives in artificial tears can become toxic and irritating to the eye if there is too much exposure with the preservative. Gel drops are slightly thicker than a regular drop, which can temporarily make vision blurry after instilling the drop. Since the gel is thicker, it stays on the front surface of the eye longer, making it a good option for a drop before going to sleep at night.

Antihistamines

Antihistamines and mast cell stabilizer combination drops are a group of OTC eye drops that are used to treat ocular allergies. When the body comes in contact with an allergen (pollen, dust mites, pet dander, etc.), it triggers an allergic reaction and the release of histamine. The symptoms associated with ocular allergies are due to the presence of histamine. Red, itchy, and swollen eyes are the most common symptoms; However, some people can also experience watering, burning, and light sensitivity. Similarly to oral antihistamines, the antihistamine eye drops work better when they are used daily throughout the allergy season compared to only using the drop as needed.

Antibiotics

Antibiotics only treat bacterial infections. There is no benefit to taking an antibiotic in the presence of a viral infection or ocular allergies. Antibiotics can be used to directly treat an infection or prophylactically to prevent one from occurring. Corneal ulcers and moderate to severe abrasions require antibiotics to minimize the risk of infection. Antibiotics are also used after cataract surgery for the same preventative measures. Bacterial conjunctivitis, or “pink eye”, can be treated with topical antibiotic drops. On the other hand, preseptal cellulitis (infection within the eyelid usually caused by a stye) requires an oral antibiotic.  

Steroids and Anti-Inflammatory Drops

There are many ocular conditions that require the use of steroids and/or other anti-inflammatory drops. Steroids are excellent for decreasing inflammation both internally and externally. Ocular inflammation can be due to a systemic disease, allergies, contact lens abuse, trauma, or eye surgery (cataracts and LASIK). Some types of viral conjunctivitis can also lead to inflammation, which is usually more irritating than the actual infection itself. Long-term use of topical steroids can cause cataracts and increased eye pressure, which can lead to glaucoma.

Glaucoma Medications

These eye drops help slow the progression of glaucoma by decreasing the eye pressure. In fact, the only modifiable risk factor for glaucoma is decreasing the eye pressure, which makes these drops very important in controlling glaucoma. Typically, treatment will begin with a prescription eye drop that is used every night before bedtime. If that does not adequately lower the eye pressure, there are other drops that can be added throughout the day. Surgical procedures are also available for more severe cases or those not responding well to the drops.

Pupil-Dilating Drops

Dilation (or cycloplegic) drops are used both diagnostically and therapeutically. Eye care providers use dilation drops to examine the inside of the eyes. The drops work on the iris muscles by both promoting dilation and inhibiting constriction, despite having a bright light shined into the eyes. Certain conditions, such as uveitis and corneal injuries, can heal faster and feel better with the use of cycloplegics. Atropine (a longer-acting dilation drop compared to those used during a comprehensive eye exam) can be used in varying concentrations for amblyopia treatment and myopia management.

Prescription Dry Eye Treatment

In chronic cases of dry eye syndrome, artificial tears might not be enough to alleviate symptoms. Prescription drops, such as Restasis and Xiidra, attack inflammatory cells in the lacrimal gland. By improving the status of the lacrimal gland, the body is able to produce more of its own natural tears. Unfortunately, this is typically a long-term treatment that must continue without any breaks. If the drops are stopped, the inflammatory cells return and it can take up to three months to regain symptom relief.