Artificial Tears: A Systematic Review

Abstract

Artificial tears are the mainstay of dry eye disease management, but also have a role in corneal abrasion and wound healing, pain and inflammation management, conjunctivitis, keratitis, contact lens rewetting and removal, and foreign body removal. A systematic review of randomized controlled trials (PROSPERO registration CRD42022369619) comparing the efficacy of artificial tears in patients with dry eye to inform prescribing choices using Web of Science, PubMed and Medline databases identified 64 relevant articles. There is good evidence that artificial tears improve symptoms of dry eye disease within a month of regular use, applied about four times a day, but signs generally take several months to improve. Not all patients with dry eye disease benefit from artificial tears, so if there is no benefit over a month, alternative management should be considered. Combination formulations are more effective than single active ingredient artificial tears. Artificial tears containing polyethylene glycol are more effective than those containing carboxymethylcellulose/carmellose sodium and hydroxypropyl methylcellulose. Those classified as having evaporative dry eye disease, benefit from artificial tears with liposomes, especially of higher concentration. The data available is limited by the definition of dry eye disease applied in published studies being variable, as well as the disease severity examined and compliance with artificial tears being rarely quantified.

Keywords:

• artificial tears
• dry eye
• comfort
• contact lenses

Summary

Artificial tears are the mainstay of DED management, but also have a role in corneal abrasion and wound healing, pain and inflammation management, conjunctivitis, keratitis, contact lens rewetting and removal, and foreign body removal. A review of randomized controlled trials comparing artificial tears identified 64 papers. There is good evidence that artificial tears improve symptoms of DED within a month of regular use, applied ~4x a day, but signs generally take several months. Not all patients with DED benefit from artificial tears, so if there is no benefit over a month, alternative management should be considered. Combination formulations are more effective than single active ingredient artificial tears. PEG containing artificial tears are more effective than those containing CMC and HPMC. Those classified as having evaporative DED, benefit from artificial tears with liposomes, especially of higher concentration.

Disclosure

JSW is on the executive of the Tear Film and Ocular Surface Society and the Aston University Optometry Research Group have received research funding from Alcon, the Eye Doctor, Scope Ophthalmic and Thea Pharmaceuticals. No funding was received to conduct this review. The authors report no other conflicts of interest in this work.