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 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...

Breed predisposition to congenital alacrima in dogs.

Related Articles

Breed predisposition to congenital alacrima in dogs.

Vet Ophthalmol. 2009 Jan-Feb;12(1):1-5

Authors: Westermeyer HD, Ward DA, Abrams K

OBJECTIVE: To evaluate the clinical characteristics and breed predisposition of congenital alacrima in dogs. Animals studied Dogs with congenital keratoconjunctivitis sicca. PROCEDURES: A search of the medical records of the University of Tennessee Veterinary Teaching Hospital from 1974-2005 and the University of California-Davis Veterinary Teaching Hospital from 1986-2006 for dogs under 1 year of age with a diagnosis of keratoconjunctivitis sicca (KCS) was performed. These cases were further reviewed for dogs with a Schirmer's tear test I of <or= 5 mm/min before 6 months of age, with no known causes for KCS, which did not respond to appropriate KCS therapy; these cases were considered to have congenital alacrima. These breeds were compared to all other breeds using the Fisher's exact test with correction for multiple comparisons. RESULTS: Congenital alacrima was identified in 19 dogs representing 11 breeds and mixed breeds. Yorkshire Terriers and Bedlington Terriers were statistically overrepresented compared to reference populations (P < 0.01 and P = 0.04, respectively). CONCLUSIONS: Yorkshire terriers are significantly at risk for congenital alacrima compared to other breeds. The significance of the increase in congenital alacrima in Bedlington Terriers in this study may not be clinically relevant and may be due to the small total number of dogs of this breed that presented to the both hospitals. Based on the poor response to therapy in humans with congenital alacrima, it may be prudent to offer guarded prognoses for KCS in juvenile Yorkshire terriers.

PMID: 19152591 [PubMed - indexed for MEDLINE]