For years, artificial tears were the default recommendation for almost anyone with dry eyes. They still have an important place in treatment, but the thinking behind them has changed. As our understanding of ocular surface disease has evolved, so has the role of lubricating therapy.
During a recent Dry Eye Fireside Chat, Damon Dierker, OD, FAAO, and Mile Brujic, OD, explored why lubricating drops remain essential while no longer standing alone in modern dry eye management.
Artificial tears fast facts
- Artificial tears remain an important component of dry eye management but are no longer considered stand-alone therapy.1
- Preservative-free lubricants are preferred for most patients with chronic dry eye disease.1
- The best lubricant depends on the underlying cause of dry eye.1,2
- A patient's response to artificial tears can sometimes provide valuable diagnostic information.
- Persistent symptoms despite frequent lubrication should prompt reassessment for meibomian gland dysfunction (MGD), inflammation, or neuropathic ocular pain.1,2
- New prescription therapies have expanded treatment options for evaporative dry eye disease.3
Treat the disease, not just the symptoms
The biggest change in dry eye management isn't the number of products available. It's the way clinicians think about the disease.
Artificial tears still provide rapid symptom relief and remain an important part of patient care. What has changed is the goal of treatment. Rather than relying on lubrication alone, clinicians now focus on identifying the mechanisms driving ocular surface disease and treating those underlying causes.1
“Artificial tears are supplemental in nature, but really they're not the mainstay of treatment.”
Two patients may describe the same symptoms, burning, irritation, fluctuating vision, or foreign body sensation, yet have very different disease processes. One may have aqueous-deficient dry eye, another evaporative disease caused by meibomian gland dysfunction (MGD), while a third may have neuropathic ocular pain. Similar symptoms do not always require the same treatment.1,5
Lubricating drops still have an important role, but today they are used as part of a broader treatment strategy that improves comfort while therapies directed at the underlying disease begin to work.1
The recommendation is part of the treatment
One of the most valuable insights from the discussion extends well beyond dry eye.
“Patients will usually not take things more seriously than we do.”
A casual suggestion to "pick up an artificial tear" often leaves patients standing in front of dozens of over-the-counter products with little understanding of how they differ. Some may unknowingly choose redness-relieving or preserved drops that are poorly suited for chronic dry eye.2
Instead, clinicians should recommend a specific product and explain why it fits the patient's presentation. Preservative-free formulations remain the preferred choice for many patients with chronic disease,1 while hyaluronic acid-containing lubricants have demonstrated excellent hydration, tear film retention, and ocular surface protection.4
Lubrication can be diagnostic
One of the most useful clinical insights from the discussion had nothing to do with choosing a lubricant. It had to do with how patients respond to one.
Patients who experience temporary relief after using artificial tears are often responding to tear film instability or ocular surface disease. Patients who report little or no improvement despite frequent use may warrant further evaluation for neuropathic ocular pain or another condition where additional lubrication alone is unlikely to solve the problem.2
That same principle applies to evaporative dry eye. Patients with MGD often feel better immediately after instilling artificial tears, only to become symptomatic again 30 to 45 minutes later. That pattern suggests the problem may not be insufficient tears, but excessive tear evaporation.1,2
Newer anti-evaporative therapies, including perfluorohexyloctane ophthalmic solution (MIEBO, Bausch + Lomb), address that mechanism by stabilizing the tear film's lipid layer rather than simply replacing aqueous tears.3 Nutritional support, lid hygiene, warm compresses, and other targeted therapies may also complement lubricating drops as part of an individualized treatment plan.1,5
Final thoughts
Artificial tears have not become obsolete. They've become more intentional. Perhaps that's the biggest shift in dry eye management. Artificial tears still have an important place in treatment, but they are no longer expected to do all the work.
Today's goal is to understand why the ocular surface is unhealthy and treat the underlying disease. The question is no longer simply, "Which artificial tear should I recommend?" It's "What is driving this patient's symptoms?"
Once clinicians answer that question, lubricating therapy becomes far more purposeful and, ultimately, more effective.
This article was written by Dianne Barnard, RN based on the recorded conversation between Drs. Dierker and Brujic.
