Dry eyes are a common condition that can cause symptoms like stinging, burning, itching, redness, and a gritty sensation. These symptoms occur when your eyes don’t produce enough tears or when the quality of your tears is poor. Choosing the right eye drops depends on how severe your symptoms are, the underlying cause of your dry eye, and your individual needs. This guide will help you navigate over-the-counter (OTC) and prescription options to find the best relief.

What Types of Eye Drops Are Available for Dry Eyes?

A variety of different eye drops are available to help manage dry eyes. These treatments aim to lubricate the eyes, supplement natural tear production, reduce inflammation, or prevent tear evaporation. The main categories include over-the-counter (OTC) artificial tears and prescription medications.

Over-the-Counter (OTC) Relief

Artificial tears are the first line of defense for most people with dry eyes. They work by supplementing your natural tears to lubricate and moisturize the eye surface. These come in various formulations:

• Lubricating Eye Drops (Demulcents): These are the most common type of artificial tears. They contain ingredients like carboxymethylcellulose, hydroxypropyl methylcellulose, glycerin, polyethylene glycol, or polyvinyl alcohol, which help to soothe and hydrate the eyes.
• Lipid-Based or Emollient Drops: For those whose dry eyes are caused or worsened by rapid tear evaporation, these drops contain oils (such as castor oil or mineral oil) or other lipids. They help to stabilize the oily outer layer of the tear film, preventing tears from drying up too quickly.
• Electrolyte-Containing Drops: Some artificial tears include electrolytes like potassium and sodium, which are naturally found in tears and can help promote a healthy ocular surface.
• Gels and Ointments: These are thicker formulations that provide longer-lasting lubrication. They can temporarily blur vision and are often recommended for nighttime use or for individuals with more severe or persistent dryness.

Prescription Relief

If OTC options don't provide sufficient relief, an eye doctor may prescribe stronger or more targeted therapies:

• Cyclosporine (e.g., Restasis, Cequa, Vevye): This immunomodulator helps to reduce inflammation, a common underlying cause of chronic dry eye. By decreasing inflammation, it can help your eyes produce more of their own tears.
• Lifitegrast (e.g., Xiidra): This medication also targets inflammation by blocking certain proteins involved in the inflammatory process on the eye's surface, thereby helping to improve tear production and reduce dry eye symptoms.
• Perfluorohexyloctane (e.g., Miebo): This is a newer type of prescription drop specifically designed to target tear evaporation by forming a protective layer over the tear film, mimicking the function of the natural lipid layer.
• Loteprednol Etabonate (e.g., Eysuvis, Lotemax): These are corticosteroid eye drops prescribed for short-term use to manage acute flare-ups of dry eye disease by significantly reducing inflammation. Due to potential side effects with long-term use, they are typically used under close medical supervision.
• Tyrvaya (Varenicline) Nasal Spray: A nasal spray used to increase production of tears by activating nerves in the nose.
• Autologous Serum Eye Drops: In severe cases, eye drops can be custom-made from a patient's own blood serum. These drops contain growth factors and nutrients that can help heal the ocular surface.

Best Eye Drops by Severity of Dry Eye Symptoms

Certain eye drops may be better depending on the severity of dry eye symptoms.

Best for Mild Symptoms

For occasional dryness, regular OTC artificial tears are usually sufficient. If eye drops containing preservatives are irritating, try preservative-free options.

Best for Moderate Symptoms

If you experience daily or frequent dryness, switch to preservative-free artificial tears to avoid irritation from additives. Lipid-based formulations are helpful if your dry eye is related to tear evaporation.

Best for Severe Symptoms

Persistent or inflammatory dry eye often requires prescription drops such as Restasis (cyclosporine), Xiidra (lifitegrast), or Cequa (cyclosporine solution). These reduce inflammation and help increase natural tear production

Best Eye Drops by Type of Dry Eye Disease

The best eye drop often depends on the specific type of dry eye a person has. Two primary examples are evaporative dry eye (EDE) and aqueous-deficient dry eye (ADDE), with ADDE sometimes linked to autoimmune conditions like Sjögren's syndrome.

Here's a breakdown of recommended eye drop types for these conditions:

Evaporative Dry Eye (EDE)

EDE occurs when the meibomian glands in the eyelids don't produce enough quality oil (meibum) to form a stable lipid layer on the tear film. This causes tears to evaporate too quickly. The best eye drops for EDE aim to replenish or protect this oily layer:

• Lipid-Based Artificial Tears: These are often the first line of treatment. They contain oils like castor oil, mineral oil, or other lipid components designed to supplement the deficient oily layer of the tears, reduce evaporation, and stabilize the tear film.
• Perfluorohexyloctane Ophthalmic Solution (e.g., Miebo): This is a newer prescription eye drop specifically designed to target evaporative dry eye. It forms a monolayer at the tear film surface to directly inhibit tear evaporation. It does not contain water or preservatives.
• Preservative-Free Options: For those needing frequent application, preservative-free formulations of lipid-based tears are recommended to avoid potential irritation from preservatives that can exacerbate EDE.

Aqueous-Deficient Dry Eye (ADDE)

ADDE results from the lacrimal glands not producing enough of the watery component of tears. This type is common in autoimmune diseases like Sjögren's syndrome. Treatment focuses on increasing tear production, reducing inflammation, and providing lubrication:

• Preservative-Free Artificial Tears: Due to the often severe and chronic nature of ADDE, especially in Sjögren's syndrome, frequent lubrication is essential. Preservative-free artificial tears are strongly recommended to avoid preservative-induced toxicity and inflammation. Various formulations are available, and patients may need to try different ones to find what works best.
• Cyclosporine (e.g., Restasis, Cequa, Vevye): These prescription immunomodulators help to reduce underlying inflammation that impairs tear production, thereby helping the eyes produce more of their own tears over time. They are often a cornerstone of treatment for ADDE, including Sjögren's-related dry eye.
• Lifitegrast (e.g., Xiidra): This prescription drop also targets inflammation by blocking specific proteins involved in the inflammatory cascade on the eye's surface. It can improve symptoms and increase tear production.
• Varenicline Solution Nasal Spray (e.g., Tyrvaya): This is a unique prescription treatment that stimulates natural tear production through a nasal spray mechanism, activating a nerve pathway. It can be beneficial for those with ADDE.
• Autologous Serum Eye Drops: For severe cases of ADDE, particularly in Sjögren's syndrome where the ocular surface may be significantly damaged, these custom-made drops derived from the patient's own blood can provide essential growth factors and nutrients to promote healing and lubrication. They are typically reserved for when other treatments are insufficient.
• Corticosteroid Eye Drops (Short-Term): In cases of acute inflammatory flare-ups, a short course of prescription corticosteroid drops (e.g., loteprednol) may be used to quickly reduce inflammation. However, due to potential side effects like increased eye pressure and cataract formation, they are not for long-term use.

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How to Choose the Right Eye Drops for You

It's vital to have an eye care professional (optometrist or ophthalmologist) diagnose the specific type of dry eye, as this will guide the most effective treatment strategy. Many individuals have a mixed form of dry eye with both evaporative and aqueous-deficient components. As a general rule, if eye drops are needed more than four times a day, preservative-free options are preferable to minimize potential irritation and toxicity. This is especially important for individuals with ADDE and Sjögren's syndrome. For nighttime relief, consider longer-lasting gels or ointments. Always follow package instructions or your medical professional’s advice.

When Should You See an Eye Doctor?

There are some situations that warrant evaluation by a healthcare professional, including:

• If OTC products fail after consistent use.
• If you have severe symptoms or underlying autoimmune conditions.
• If you notice sudden changes like pain, light sensitivity, or vision loss.

An eye doctor can diagnose the type of dry eye and recommend advanced treatments if needed.

Are There Side Effects or Precautions?

Both over-the-counter (OTC) and prescription eye drops can have side effects, though they vary in type and severity depending on the specific ingredients and the individual using them.

OTC artificial tears, gels, and ointments are generally considered safe, but some individuals may experience:

• Temporary Blurred Vision: This is common, especially with thicker gel or ointment formulations, immediately after application. It usually clears up quickly.
• Stinging or Burning Sensation: Some drops may cause a mild, temporary stinging or burning feeling upon instillation. This often subsides with continued use, but if it's severe or persistent, you should discontinue use and consult a doctor.
• Allergic Reactions: Though rare, some people can be allergic to certain ingredients or preservatives in eye drops. Symptoms can include itching, redness, swelling of the eyelids, or worsening of dry eye symptoms.
• Eye Discomfort or Irritation: If a particular formulation doesn't agree with your eyes, it might cause general discomfort.
• Crusting on Eyelashes: Some drops, particularly ointments, can leave a residue

Many multi-dose OTC eye drops contain preservatives to prevent bacterial contamination. For some people, especially those with moderate to severe dry eye or who use drops frequently, these preservatives can cause irritation, inflammation, and even damage to the ocular surface over time. Preservative-free formulations, available in single-use vials or specially designed multi-dose bottles, are often recommended to avoid these issues.

Prescription eye drops often have more targeted mechanisms of action and, as such, can have more specific and sometimes more significant side effects. It's important to discuss these with your eye doctor. Some common side effects of prescription eye drops include:

• Cyclosporine (e.g., Restasis, Cequa, Vevye): Burning or stinging sensation upon instillation (this is quite common, especially initially), eye redness, watery eyes, eye discharge, foreign body sensation, itching, and blurred vision.
• Lifitegrast (e.g., Xiidra): Eye irritation, stinging, or burning upon instillation, an unusual or metallic taste sensation (dysgeusia), and blurred vision.
• Perfluorohexyloctane (e.g., Miebo): Blurred vision, eye redness, and eye pain or stinging have been reported.
• Loteprednol Etabonate (e.g., Eysuvis, Lotemax): Temporary burning or stinging, blurred vision. With long-term use, these drops can cause increased intraocular pressure (which can lead to glaucoma), cataract formation, delayed wound healing, and increased risk of eye infections.
• Varenicline Solution Nasal Spray (Tyrvaya): Sneezing, cough, throat irritation, and nose irritation.

Which Brands and Products Are Commonly Recommended?

Some brands of OTC eye drops that are commonly recommended include Systane, Refresh, TheraTears, Blink, and iVizia. These brands typically offer a variety of different products to choose from. Prescription options typically recommended for dry eye include Restasis, Xiidra, and Cequa. Your healthcare professional can help you determine the best option to treat your dry eye symptoms.

Can Eye Drops Be Combined with Other Treatments?

Yes, eye drops are very often combined with other treatments as part of a comprehensive management plan for dry eye disease. In fact, a multi-faceted approach is typically the most effective way to address the various underlying causes and symptoms of dry eyes.

Warm Compresses and Eyelid Hygiene

Warm compresses help to melt the thick oils blocking the meibomian glands (which produce the oily layer of the tear film), and are especially beneficial for evaporative dry eye. Eyelid hygiene (using specific cleansers or scrubs) helps to remove debris, bacteria, and Demodex mites that can contribute to gland dysfunction and inflammation. Using lubricating or lipid-based eye drops after warm compresses and eyelid cleaning can help to replenish the tear film and soothe the ocular surface once the glands are clearer and the eyelids are clean.

Punctal Plugs

Punctal plugs are tiny devices inserted into the tear ducts (puncta) to block tear drainage. This helps to keep natural tears, as well as any artificial tears you instill, on the eye surface for a longer period. Patients with punctal plugs will often continue to use artificial tears, especially if their natural tear production is low (aqueous-deficient dry eye). The plugs help to maximize the effectiveness of the drops.

Dietary Supplements (e.g., Omega-3 Fatty Acids)

Omega-3 fatty acids, often taken orally as fish oil or flaxseed oil supplements, are thought to improve the quality of the meibomian gland secretions and have anti-inflammatory effects. While omega-3s work systemically over time, eye drops provide immediate, topical relief from dryness symptoms. The two can be used concurrently as part of a long-term management strategy.

Lifestyle Modifications

Various lifestyle adjustments can reduce dry eye symptoms. These include:

• Staying hydrated: Drinking plenty of water.
• Blinking regularly: Especially during prolonged screen use.
• Using a humidifier: To add moisture to dry indoor air.
• Avoiding direct wind: From fans, air conditioners, or hair dryers.
• Wearing wraparound sunglasses: To protect eyes from wind and sun.
• Managing screen time: Taking frequent breaks.

It's important to discuss all treatments you are using or considering with your eye care professional. They can develop a tailored plan that addresses your specific type of dry eye and ensure that the combined therapies are safe and effective for you.

References

1. American Academy of Ophthalmology. 2019. Treating Evaporative Dry Eye Associated With Meibomian Gland Dysfunction. Accessed on May 30, 2025 at https://www.aao.org/eyenet/article/treating-evaporative-dry-eye
2. American Academy of Ophthalmology. 2024. Choosing the Best Lubricant Eye Drops for Dry Eyes. Accessed on May 30, 2025 at https://www.aao.org/eye-health/tips-prevention/how-to-choose-lubricant-drops-dry-eyes
3. Donthineni, P. R., et. al. 2023. Aqueous-deficient dry eye disease: Preferred practice pattern guidelines on clinical approach, diagnosis, and management. Indian journal of ophthalmology, 71(4), 1332–1347. https://doi.org/10.4103/IJO.IJO_2808_22
4. Kojima, T., et. al. 2005. The effect of autologous serum eyedrops in the treatment of severe dry eye disease: a prospective randomized case-control study. American journal of ophthalmology, 139(2), 242–246. https://doi.org/10.1016/j.ajo.2004.08.040
5. Labetoulle, M., et. al. 2022. Artificial Tears: Biological Role of Their Ingredients in the Management of Dry Eye Disease. International journal of molecular sciences, 23(5), 2434. https://doi.org/10.3390/ijms23052434
6. Rolando, M., et. al. 2022. Management Strategies for Evaporative Dry Eye Disease and Future Perspective. Current eye research, 47(6), 813–823. https://doi.org/10.1080/02713683.2022.2039205

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