Artificial Tear Eye Drops After Lasik

Every artificial tear manufacturer has a slightly different formula for each brand. Some eye drops are thick to provide more protection, others are thin to provide rapid relief without vision disruption, however all can be divided into one of three categories: preserved, preservative free, preservative free on contact.

The preservatives used in artificial tears are a mild toxin. A purpose of a toxin in an artificial tear is to kill anything that may promote spoilage of the eye drops and to keep the eye drops aseptic.

The eye does not like toxins too much, even low level toxins. Toxins in eye drops can cause irritation, redness, even inflammation. An eye healing from conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, NearVision CK, RLE, or any refractive surgery procedure, needs all the help it can get and applying a toxin is not helpful. Even if the eye drops do not cause irritation and feel fine, the toxins may be slowing or negatively affecting the healing process.

Newer "preservative free on contact" artificial tears have an advantage that the toxin quickly dissipates, but the speed at which the toxin dissipates varies greatly. As an example, one such drop dissipates the preservative by exposure to ambient light. If you put in the drops, close your eyes, and go to bed with the lights out, that preservative is not going to dissipate very quickly. Artificial tears that claim to be preservative free on contact are not necessarily appropriate immediately after surgery.

It is always best to use true preservative free eye drops during the immediate recovery period after Lasik or similar laser eye surgery. It is even a good idea to use preservative free eye drops long after surgery, but they are more expensive and after the cornea has healed adequately an artificial tear with a preservative or is preservative free on contact may be appropriate. Check with your doctor.

If eye irritation is experiences with the use of a preservative free artificial tear, it may be the formulation is incompatible. It is possible that something in a particular formula of a particular brand is causing irritation, with or without a preservative. You would need to try different brands to see what works best for you. Listed below are several of the major artificial tears categorized by active ingredients.

Artificial Tear Eye Drops Hydroxypropyl Methylellulose (HPMC) Artificial Tears Bion Tears 0.3% HPMC, 0.1% Dextran 70. (bicarbonate & zinc help mucus & surface cells), Preservative-free. Tears Naturale Forte 0.3% HPMC, 0.1% Dextran 70, 0.2% Glycerin Polyquad 0.001% as preservative.  Tears Natural II Polyquad 0.3% HPMC, 0.1% Dextran 70, Polyquad 0.001% as preservative. Tears Natural Free 0.3% HPMC, 0.1% Dextran 70, Preservative-free.  GenTeal Mild Active ingredient: HPMC, 0.2%  Inactive ingredients: Boric acid, calcium chloride dihydrate, sodium perborate, phosphonic acid, potassium chloride, purified water, and sodium chloride. GenTeal Moderate Active ingredient: HPMC, 0.3% Inactive ingredients: Boric acid, sodium perborate, phosphonic acid, potassium chloride, purified water, and sodium chloride. GenTeal Severe Active ingredient: HPMC, 0.3% Inactive ingredients: Boric acid, calcium chloride, magnesium chloride, potassium chloride, purified water, sodium borate, sodium chloride, and zinc sulfate. Visine tears 0.2% HPMC, 0.2% Glycerin, 1% Polyethylene Glycol 400, Benzalkonium Chloride (0.01%) as preservative. Visine is also available as Preservative Free single-use vials Carboxyl Methylcellulose (CMC) Artificial Tears Refresh Tears 0.5% CMC, Purite as preservative. Refresh Plus Tears also has 0.5% CMC, but is preservative free & comes in single use vials. Refresh Liquigel 1% CMC, Purite as preservative. Refresh Celluvisc also has 1% CMC, but is preservative free & comes in single use vials. Thera Tears 0.25% CMC, Hypotonic, Preservative-free. Single-use container pack. Polyvinyl Alcohol (PVA) Artificial Tears Murine Tears 0.5% Polyvinyl Alcohol , 0.6% Povidone. (has Bicarbonate), Benzalkonium Chloride (0.01%) as preservative.  Manufactured by Ross (Abbott Labs) HypoTears 1% Polyvinyl Alcohol , 1% Polyethylene Glycol 400. Hypotonic, Benzalkonium Chloride (0.01%) as preservative. Hypotears is also available as Preservative free single-use vials Akwa Tears 1.4% Polyvinyl Alcohol. Hypotonic, Benzalkonium Chloride (0.005%) as preservative. MiniDrops Eye Therapy Active Ingredients (in each ml): Polyvinylpyrrolidone (6 mg), Polyvinyl Alcohol (14 mg). Inactive Ingredient: Sodium Chloride. Preservative free single-use vials Tears Again 1.4% Polyvinyl Alcohol. Glycerine Artificial Tears & Others Systane Polyethylene Glycol 400 0.4% (lubricant), Propylene Glycol 0.3% (lubricant), Hydroxypropyl Guar (Gel forming Matrix), Polyquaternium-1 as preservative. Advanced Eye Relief 1% Propylene Glycol, 0.3% Glycerin Benzalkonium Chloride (0.01%) as preservative. Similasan homeopathic Belladonna HPUS 6X alkaloids, Euphrasia, Mercurius sublimatus. Sodium silver chloride complex 0.001% as preservative. Tetrahydrozoline HCl Artifical Tears Visine AC Active Ingredients: Tetrahydrozoline HCl 0.05%, Zinc sulfate 0.25% Oil Containing Eye Drops - Prevent Evaporation of Tears Refresh Endura Castor oil, polysorbate-80, Carbomer 1342 & Glycerin, Preservative Free. Soothe Emollient Eye Drops Light mineral oil 1.0%, Mineral oil 4.5% (Restoryl), polysorbate-80, Polyhexamethylene biguanide as preservative. Contact Lens Rewetting Drops (can be used while wearing soft or hard/gas permeable contact lens) Clerz Plus Tetronic 1304 helps lens retain moisture & shields from protein build up. RLM-100 removes lens deposits. Polyquad® is the preservative. Aquify Comfort Drops Sodium Hyaluronate 0.1%, Sodium Perborate is the preservative. Complete Blink-N-Clean Lens Drops Hydroxypropyl methylcellulose is the lubricant, tyloxapol is the surfactant. Polyhexamethylene biguanide is the preservative. Opti-Free Express Rewetting drops Sterile, buffered, isotonic, aqueous solution. No hydrogel lubricants. Polyquad is the preservative. Moisture Plus Rewetting Drops Sterile, buffered, isotonic, aqueous solution. No hydrogel lubricants. Preservative-free. ReNu Rewetting drops Poloxamine removes dirt & protein deposits. Sorbic Acid is the preservative. Eye Ointments & Gels Refresh PM ointment 57.3% White Petrolatum, 42.5% Mineral Oil Preservative Free. Tears Naturale PM 56.8% White Petrolatum, 42.5% Mineral Oil Preservative Free. Genteal Gel 0.3% Hydroxypropyl Methylcellulose, Carbopol 980 GenAqua (Sodium Perborate) as preservative. Tears Again NIGHT & DAY Gel 1.5% Carboxy Methylcellulose, Dissipate (stabilized oxyborate complex) as a preservative.

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, NearVision CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

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Current Artificial Tears Medical Journal News...

Plugs for occlusion of the lacrimal drainage system.

Related Articles

Plugs for occlusion of the lacrimal drainage system.

Dev Ophthalmol. 2008;41:193-212

Authors: Tost FH, Geerling G

Background: Next to medical therapy, blockage of the lacrimal drainage system is the commonest form of treating dry eye. Rather than applying an artificial tear, the latter helps to preserve any remaining natural tear fluid, which by far has the best wetting and nutrient capacity for the ocular surface. A temporary block is usually induced by implants to tamponade on the level of the lacrimal puncta or canaliculi. Materials and Methods: A Medline search was performed with the keywords 'lacrimal drainage system, punctum, canaliculus, temporary occlusion, plug, dry eye, keratoconjunctivitis sicca' for the years 1986-2006. Plugs are a suitable treatment in patients with moderate or more severe disease. The characteristics of the devices used and procedures as well as the complications described were analyzed. Results: Criteria such as a lack of Schirmer strip wetting, ocular surface staining and the frequency of artificial tears instillation should be assessed prior to making the decision to occlude the lacrimal drainage. Lacrimal plugs made of silicone or a thermodynamic acrylic polymer, such as hydrogel, appear to be safe and effective, although each patient should be followed on a long-term basis to exclude alterations of the lacrimal system such as chronic inflammatory reactions, extrusion or migration, which may all lead to discomfort. High-frequency ultrasound as a non-invasive, simple diagnostic technique can be used to identify the type or position of plug or inflammatory reaction present. Conclusion: Tamponade of the lacrimal drainage system is a simple procedure that is underused. Preserving natural tears by blocking the lacrimal drainage system can successfully maintain the integrity of the ocular surface and corneal transparency and visual acuity. In patients with moderate or severe dry eye, it is capable of improving quality of life and preventing loss of vision.

PMID: 18453770 [PubMed - in process]