Artificial tears

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Artificial tears
Artificial tears brands.jpg
A subset of various brands of artificial tears displayed in a store
Specialty ophthalmology

Artificial tears are lubricating eye drops used to relieve dryness and irritation of the ocular surface. [1] Dry eye syndrome (keratoconjunctivitis sicca) is a common ocular surface disorder and is characterized by disruption of the tear film and increased inflammation. [2]

Contents

The tear film coats the surface of the eye and is composed of 3 layers: an aqueous, lipid, and mucous layer. [3] The aqueous layer consists of a mixture of electrolytes, enzymes, antibodies, antimicrobial proteins, and other compounds. [3] The lipid layer consists of fatty compounds that are responsible for decreasing evaporation of the tear film. [3] The mucous layer contains mucins, gelatinous glycoproteins, which allow for an even distribution of the tear film over the corneal surface and decreased friction during blinking. [3]

Artificial tears are used to supplement a patient's naturally-produced tears and increase eye lubrication by mimicking characteristics of the tear film. [4] Artificial tears can be supplemented with other treatments to treat dry eye syndrome and are available over the counter. [5] Artificial tears are also used to moisten contact lenses and in eye examinations.

Chemistry

Artificial tear usage Eye drop.jpg
Artificial tear usage

Although artificial tears are used to mimic or supplement the roles of the tear film and contain water, electrolytes, and certain polymers, they do not contain the biologically active components found in naturally-produced tears. [6] Moreover, artificial tears often contain chemicals that are not present in naturally-produced tears. [6] Preparations can contain carboxymethyl cellulose, [5] polyvinyl alcohol, [5] hydroxypropyl methylcellulose [5] (a.k.a. HPMC or hypromellose), hydroxypropyl cellulose [1] and hyaluronic acid (a.k.a. hyaluronan, HA). [7]

With preservatives

Preparations can also contain preservatives in order to prolong usage and avoid bacterial contamination. [8] Preservatives include benzalkonium chloride (BAK), [8] ethylenediaminetetraacetic acid (EDTA), [8] purite, [8] chlorobutanol, [9] sodium perborate, [9] thiomersal, [9] disodium edetate, [9] and oxychloro complex (SOC). [9] Preservatives can be toxic and cause damage to the corneal epithelium. [9] For instance, high concentrations of benzalkonium chloride (BAK) can cause cytotoxicity, cause cell lysis, and reduce tear and mucin production. [9] Patients should limit their use of artificial tears with preservatives to less than four to six times a day. [10] If artificial tears need to be utilized more than four to six times a day, a preservative-free formulation should be used. [9]

Preservative-free

Preservative-free artificial formulations are indicated for patients who cannot tolerate artificial tear formulations with preservatives, patients who are using artificial tears more than four to six times a day, [10] and patients who are using multiple topical eye drops with preservatives. [9] Preservative-free eye drops are found in single vials. However, single unit-dose artificial tears without preservatives are more expensive than bottled artificial tears with preservatives. [9]

Some patients confuse over the counter drops that contain tetrahydrozoline (i.e. Visine®), a vasoconstrictor, with artificial tears. [11] Desensitization can occur with extended usage of drops containing tetrahydrozoline. [11]

Indications and effects

The most common indication for artificial tear use is dry eyes. [12] Risk factors for developing dry eyes includes increasing age, female gender, environments with low moisture, nutritional deficiencies, certain medications, and autoimmune conditions. [13] Examples autoimmune conditions are Sjogren's syndrome, autoimmune thyroid disease, and uveitis. [14] Patients with dry eyes may have an inability to produce adequate amount or quality of tears leading to a disruption in their tear film. [15] In addition, those who wear contact lenses or have undergone eye surgeries such as LASIK are at increased risk of having dry eyes. [15] Normal tears are important to keep the surface of eyes clean and moist and protect eyes from infections. They are composed of many components including enzymes that act as natural antibiotics, proteins that prevent bacterial growth, and nutrients. [16] Without adequate lubrication, patients are at risk for infection as well as irreversible scarring and damage. [15] Artificial tears are the recognized treatment of choice for this problem. [15]

Artificial tears work by adding similar lubricating elements that natural tears contain. [17] This helps thicken and stabilize the pre-corneal tear film, prolonging tear film breakup time, and allowing for tears to properly protect the surface of the eyes. [17] Most artificial tears do not require a prescription and can be used as often as needed. Patients who use artificial tears more frequently than four to six times a day should choose a brand without preservatives or one with non-irritating preservatives. [10] Thicker artificial tears that come in the form of gel or ointments may be used in more severe cases as they last longer, although they may temporarily blur vision. [1] In more severe cases, providers may prescribe a form of artificial tears that works to reduce inflammation in the tear glands in an effort to improve natural tear production and the quality of tears produced. [18]

Side effects and precautions

Artificial tears have no reported interactions. [1] The most common side effect of artificial tears is temporary blurry vision. [17] Allergic reactions have been reported and are associated with itchy or swollen eyes, dizziness, and breathing problems. [17] These symptoms warrant discontinuation of the drops and to see a physician immediately. [17] Prescription drops may have additional side effects such as burning, redness, pain, and a foreign body sensation. [12]

For contact lens users, specific drops should be used to avoid ingredients that can damage the contact lens. [12] If using multiple types of eye drops, it is important to wait a few minutes in between application of each to avoid rinsing out the prior drop. [19] Proper technique should be conducted to avoid contaminating the bottle. Washing hands prior to use and avoiding contact between the bottle and eyes can prevent infections. [19]

Veterinary uses

Artificial tears are a part of the topical therapy for keratoconjunctivitis sicca for animals such as dogs, cats and horses. [20] Similarly to human use, proper care should be performed to avoid contamination of the bottle. [21] A veterinarian should be contacted if any signs of allergy, irritation, or pain develop due to the usage of artificial tears. [21]

Research

A 2016 Cochrane Review seeking to compare the effectiveness of various over the counter artificial tears in treating dry eye. While the review stated that it is unclear which artificial tear formulation works best, two trials found that 0.2% polyacrylic acid-based tears were more effective in treating dry eye symptoms over 1.4% polyvinyl alcohol-based tears. [8]

2023 recall

On February 2, 2023, Global Pharma Healthcare issued a recall on artificial tears eye drops distributed by EzriCare and Delsam Pharma after reports of bacterial contamination. A multi-state cluster of Verona Integron-mediated Metallo-β-lactamase (VIM)- and Guiana-Extended Spectrum-β-Lactamase (GES)- producing carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA) infections from the contaminated eye drops has led to reports of eye infections, permanent loss of vision, and one death. [22] [23] [24]

See also

Related Research Articles

<span class="mw-page-title-main">Conjunctivitis</span> Inflammation of the eye

Conjunctivitis, also known as pink eye or Madras eye, is inflammation of the outermost layer of the white part of the eye and the inner surface of the eyelid. It makes the eye appear pink or reddish. Pain, burning, scratchiness, or itchiness may occur. The affected eye may have increased tears or be "stuck shut" in the morning. Swelling of the white part of the eye may also occur. Itching is more common in cases due to allergies. Conjunctivitis can affect one or both eyes.

<span class="mw-page-title-main">Contact lens</span> Lenses placed on the eyes surface

Contact lenses, or simply contacts, are thin lenses placed directly on the surface of the eyes. Contact lenses are ocular prosthetic devices used by over 150 million people worldwide, and they can be worn to correct vision or for cosmetic or therapeutic reasons. In 2010, the worldwide market for contact lenses was estimated at $6.1 billion, while the US soft lens market was estimated at $2.1 billion. Multiple analysts estimated that the global market for contact lenses would reach $11.7 billion by 2015. As of 2010, the average age of contact lens wearers globally was 31 years old, and two-thirds of wearers were female.

<span class="mw-page-title-main">Blepharitis</span> Inflammation of the eyelid

Blepharitis, sometimes known as granulated eyelids, is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis by itself is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The primary cause is bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.

<span class="mw-page-title-main">Dry eye syndrome</span> Medical condition of dry eyes

Dry eye syndrome, also known as keratoconjunctivitis sicca, is the condition of having dry eyes. Symptoms include dryness in the eye, irritation, redness, discharge, blurred vision, and easily fatigued eyes. Symptoms range from mild and occasional to severe and continuous. Dry eye syndrome can lead to blurred vision, instability of the tear film, increased risk of damage to the ocular surface such as scarring of the cornea, and changes in the eye including the neurosensory system.

<span class="mw-page-title-main">Eye drop</span> Liquid applied directly to the eye

Eye drops or eyedrops are liquid drops applied directly to the surface of the eye usually in small amounts such as a single drop or a few drops. Eye drops usually contain saline to match the salinity of the eye. Drops containing only saline and sometimes a lubricant are often used as artificial tears to treat dry eyes or simple eye irritation such as itching or redness. Eye drops may also contain one or more medications to treat a wide variety of eye diseases. Depending on the condition being treated, they may contain steroids, antihistamines, sympathomimetics, beta receptor blockers, parasympathomimetics, parasympatholytics, prostaglandins, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, antifungals, or topical anesthetics.

<span class="mw-page-title-main">Schirmer's test</span> Medical test to assess tear production

Schirmer's test determines whether the eye produces enough tears to keep it moist. This test is used when a person experiences very dry eyes or excessive watering of the eyes. It can cause damage to the cornea. A negative test result is normal. Both eyes normally secrete the same amount of tears.

<span class="mw-page-title-main">Xerophthalmia</span> Dry eye

Xerophthalmia is a medical condition in which the eye fails to produce tears. It may be caused by vitamin A deficiency, which is sometimes used to describe that condition, although there may be other causes.

<span class="mw-page-title-main">Hydroxypropyl cellulose</span> Chemical compound

Hydroxypropyl cellulose (HPC) is a derivative of cellulose with both water solubility and organic solubility. It is used as an excipient, and topical ophthalmic protectant and lubricant.

<span class="mw-page-title-main">Recurrent corneal erosion</span> Separation of the cellular layers of the cornea of the eye

Recurrent corneal erosion (RCE) is a disorder of the eyes characterized by the failure of the cornea's outermost layer of epithelial cells to attach to the underlying basement membrane. The condition is excruciatingly painful because the loss of these cells results in the exposure of sensitive corneal nerves. This condition can often leave patients with temporary blindness due to extreme light sensitivity (photophobia).

<span class="mw-page-title-main">Corneal abrasion</span> Scratch to the surface of the cornea of the eye

Corneal abrasion is a scratch to the surface of the cornea of the eye. Symptoms include pain, redness, light sensitivity, and a feeling like a foreign body is in the eye. Most people recover completely within three days.

<span class="mw-page-title-main">Phlyctenular keratoconjunctivitis</span> Medical condition

Phlyctenular keratoconjunctivitis is an inflammatory syndrome caused by a delayed hypersensitivity reaction to one or more antigens. The triggering antigen is usually a bacterial protein, but may also be a virus, fungus, or nematode.

<span class="mw-page-title-main">Corneal ulcers in animals</span> Veterinary inflammatory condition of the cornea

A corneal ulcer, or ulcerative keratitis, is an inflammatory condition of the cornea involving loss of its outer layer. It is very common in dogs and is sometimes seen in cats. In veterinary medicine, the term corneal ulcer is a generic name for any condition involving the loss of the outer layer of the cornea, and as such is used to describe conditions with both inflammatory and traumatic causes.

<i>Acanthamoeba</i> keratitis Eye infection caused by a protist

Acanthamoeba keratitis (AK) is a rare disease in which amoebae of the genus Acanthamoeba invade the clear portion of the front (cornea) of the eye. It affects roughly 100 people in the United States each year. Acanthamoeba are protozoa found nearly ubiquitously in soil and water and can cause infections of the skin, eyes, and central nervous system.

<span class="mw-page-title-main">Lagophthalmos</span> Medical condition

Lagophthalmos is the inability to close the eyelids completely.

<span class="mw-page-title-main">Corneal ulcer</span> Inflammation of the cornea of the eye due to trauma or infection

Corneal ulcer, also called keratitis, is an inflammatory or, more seriously, infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma. It is a common condition in humans particularly in the tropics and in farming. In developing countries, children afflicted by vitamin A deficiency are at high risk for corneal ulcer and may become blind in both eyes persisting throughout life. In ophthalmology, a corneal ulcer usually refers to having an infection, while the term corneal abrasion refers more to a scratch injury.

A spasm of accommodation is a condition in which the ciliary muscle of the eye remains in a constant state of contraction. Normal accommodation allows the eye to "accommodate" for near-vision. However, in a state of perpetual contraction, the ciliary muscle cannot relax when viewing distant objects. This causes vision to blur when attempting to view objects from a distance. This may cause pseudomyopia or latent hyperopia.

<span class="mw-page-title-main">Herpes simplex keratitis</span> Medical condition

Herpetic simplex keratitis is a form of keratitis caused by recurrent herpes simplex virus (HSV) infection in the cornea.

Neurotrophic keratitis (NK) is a degenerative disease of the cornea caused by damage of the trigeminal nerve, which results in impairment of corneal sensitivity, spontaneous corneal epithelium breakdown, poor corneal healing and development of corneal ulceration, melting and perforation. This is because, in addition to the primary sensory role, the nerve also plays a role maintaining the integrity of the cornea by supplying it with trophic factors and regulating tissue metabolism.

Tear break-up time (TBUT) also known as tear film break-up time (TFBUT) is the time taken for the first dry spot to appear on the cornea after a complete blink. TFBUT measurement is an easy and fast method used to assess the stability of tear film. It is a standard diagnostic procedure in the dry eye clinics. The volume of tear in the eye depends on two factors, drainage through the lacrimal passages and evaporation. Factors like decreased tear production, increased evaporation rate, tearfilm instability, tear hyperosmolarity, inflammations, ocular surface damages etc. can cause dryness to the eyes.

Exposure keratopathy is medical condition affecting the cornea of eyes. It can lead to corneal ulceration and permanent loss of vision due to corneal opacity.

References

  1. 1 2 3 4 "Keratoconjunctivitis, Sicca". eMedicine . WebMD, Inc. 2006-04-21. Archived from the original on 16 October 2006. Retrieved 2006-11-12.
  2. ↑ Cursiefen, Claus.; Jun, Albert S. (2017). Current Treatment Options for Fuchs Endothelial Dystrophy. Springer International Publishing. ISBN   978-3-319-43021-8. OCLC   979934453.
  3. 1 2 3 4 Clayton, Janine A. (2018-06-07). Longo, Dan L. (ed.). "Dry Eye". New England Journal of Medicine. 378 (23): 2212–2223. doi:10.1056/NEJMra1407936. ISSN   0028-4793. PMID   29874529. S2CID   46980680.
  4. ↑ Perry, Henry D.; Donnenfeld, Eric D. (December 2003). "Medications for dry eye syndrome: a drug-therapy review". Managed Care (Langhorne, Pa.). 12 (12 Suppl): 26–32. ISSN   1062-3388. PMID   14723111.
  5. 1 2 3 4 Moshirfar M, Pierson K, Hanamaikai K, Santiago-Caban L, Muthappan V, Passi SF (July 2014). "Artificial tears potpourri: a literature review". Clin Ophthalmol. 8: 1419–33. doi: 10.2147/OPTH.S65263 . PMC   4124072 . PMID   25114502.
  6. 1 2 Dogru, Murat; Tsubota, Kazuo (2011-01-10). "Pharmacotherapy of dry eye". Expert Opinion on Pharmacotherapy. 12 (3): 325–334. doi:10.1517/14656566.2010.518612. ISSN   1465-6566. PMID   21214414. S2CID   25217717.
  7. ↑ Troiano P, Monaco G (27 December 2008). "Effect of hypotonic 0.4% hyaluronic acid drops in dry eye patients: a cross-over study". Cornea. 27 (10): 1126–30. doi:10.1097/ICO.0b013e318180e55c. PMID   19034126. S2CID   41027463.
  8. 1 2 3 4 5 Pucker AD, Ng SM, Nichols JJ (2016). "Over the counter (OTC) artificial tear drops for dry eye syndrome". Cochrane Database Syst Rev. 2016 (2): CD009729. doi:10.1002/14651858.CD009729.pub2. PMC   5045033 . PMID   26905373.
  9. 1 2 3 4 5 6 7 8 9 10 Ribeiro, Marina Viegas Moura Rezende; Barbosa, Fabiano Timbó; Ribeiro, Luiz Eduardo Feliciano; Sousa-Rodrigues, Célio Fernando de; Ribeiro, Eurica Adélia Nogueira (2019). "Effectiveness of using preservative-free artificial tears versus preserved lubricants for the treatment of dry eyes: a systematic review". Arquivos Brasileiros de Oftalmologia. 82 (5): 436–445. doi: 10.5935/0004-2749.20190097 . ISSN   0004-2749. PMID   31508669.
  10. 1 2 3 "Dry Eye Diagnosis and Treatment". American Academy of Ophthalmology. 2019-08-23. Retrieved 2020-01-21.
  11. 1 2 Soparkar, Charles N. S. (1997-01-01). "Acute and Chronic Conjunctivitis Due to Over-the-counter Ophthalmic Decongestants". Archives of Ophthalmology. 115 (1): 34–8. doi:10.1001/archopht.1997.01100150036004. ISSN   0003-9950. PMID   9006422.
  12. 1 2 3 Meadows, Michelle (May–June 2005). "Dealing with Dry Eye". FDA Consumer . 39 (3). U.S. Food and Drug Administration: 8–9. PMID   16127813. Archived from the original on January 20, 2009. Retrieved 14 May 2016.
  13. ↑ "Dry Eye Disease: Prevalence, Assessment, and Management". insights.ovid.com. Archived from the original on 2020-01-14. Retrieved 2020-01-16.
  14. ↑ Hessen, Michelle; Akpek, Esen Karamursel (April 2014). "Dry Eye: an Inflammatory Ocular Disease". Journal of Ophthalmic & Vision Research. 9 (2): 240–250. ISSN   2008-2010. PMC   4181208 . PMID   25279127.
  15. 1 2 3 4 Moshirfar, Majid; Pierson, Kasey; Hanamaikai, Kamalani; Santiago-Caban, Luis; Muthappan, Valliammai; Passi, Samuel F (2014-07-31). "Artificial tears potpourri: a literature review". Clinical Ophthalmology. 8: 1419–1433. doi: 10.2147/OPTH.S65263 . ISSN   1177-5467. PMC   4124072 . PMID   25114502.
  16. ↑ "Facts About Tears". American Academy of Ophthalmology. 2016-12-21. Retrieved 2020-01-23.
  17. 1 2 3 4 5 "Lubricating Eye Drops". American Academy of Ophthalmology. 2018-08-15. Retrieved 2020-01-22.
  18. ↑ "Multi-dose Restasis approved". American Academy of Ophthalmology. 2016-10-31. Retrieved 2020-01-23.
  19. 1 2 "Eye Drop Tips". Glaucoma Research Foundation. Retrieved 2020-01-23.
  20. ↑ "Keratoconjunctivitis, Sicca". The Merck Veterinary Manual . Merck & Co., Inc. Archived from the original on 2007-03-16. Retrieved 2006-11-18.
  21. 1 2 "Artificial Tear Solutions for Dogs and Cats". www.petplace.com. Retrieved 2020-01-23.
  22. ↑ "Global Pharma Healthcare Issues Voluntary Nationwide Recall of Artificial Tears Lubricant Eye Drops Due to Possible Contamination". Food and Drug Administration. February 2, 2023. Retrieved February 13, 2023.
  23. ↑ Archie, Ayana (February 3, 2023). "Manufacturer recalls eye drops after possible link to bacterial infections". NPR . Retrieved February 13, 2023.
  24. ↑ Roberts, Catherine (February 3, 2023). "Eye Drops Recalled Due to Potential Bacterial Contamination". Consumer Reports . Retrieved February 13, 2023.
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