Not always a clear choice
Other situations may not be so clear-cut. One area where the use of artificial tears is exploding is in relief of the chronic “tired eyes” complaint that often accompanies workers who spend all day in front of a computer screen.
In contrast to traditional dry eye, this situation is at least in part due to a tiredness that goes beyond the eyes. Many relieve the condition with a cup of coffee, a trip to the water fountain, or any temporary activity that breaks the monotony of the computer monitor.
A number of artificial tears products are designed to do this as well, acting as a variation to the “splash of water in the face.” Such products—including Visine Tired Dry Eyes, Clear Eyes Cooling Comfort, or Rohto Cooling Drops—are promoted as addressing this phenomenon of tired eyes. All of these products, as well as others designed to treat tired eyes, report a long duration of action. For these patients, it is probably less important to have a drop that is long-lasting, and more important to achieve a rapid, rejuvenating feeling.
Some patients are more concerned about how their eyes look and depend on products that include some form of redness relief. Many drops are available that include an adrenergic agent (typically naphazoline HCl) that provides a fast, effective means to reduce conjunctival hyperemia. The caveat to these products is that they can be overused, and this can result in an ocular irritation (most likely due to repeated exposure to drop preservative) that can include both redness and dry eye.
An underappreciated cause of ocular surface irritation and subsequent artificial tear use is systemic prescription medication. Anti-depressants and anxiolytics are particularly notorious for an association with dry eye, and some of these may also have long-term ocular side effects.1
Ocular drying is also associated with any drug that possesses anti-cholinergic effects, such as anti-histamines or drugs used to treat Parkinson’s disease. The anti-cholinergic effect implies a negative impact on lacrimation, so these patients are likely candidates for traditional aqueous artificial tear preparations, especially those designed for a long duration of action.
Gail L. Torkildsen, MD
e: [email protected]
Dr. Torkildsen is in private practice in Andover, MA, and also does consulting in ophthalmic clinical research. She did not indicate any proprietary interest in the subject matter.
1. Wong J, Lan W, Ong LM, Tong L. Non-hormonal systemic medications and dry eye. Ocul Surf. 2011;9:212-226.
2. Moshirfar M, Pierson K, et al. Artificial tears potpourri: a literature review. Clin Ophthalmol. 2014;8:1419-1433.
3. Torkildsen G, Brujic M, Cooper MS, et al. Evaluation of a new artificial tear formulation for the management of tear film stability and visual function in patients with dry eye. Clin Ophthalmol. 2017;11:1883–1889.