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Eye drop frequency of use (1/2023)Updated a year ago

Over-the-counter (OTC) lubricant eye drops, gels and ointments

Survey conducted: January 3 to 9, 2023

Participants: 366

Comments: 79

QUESTION 1: On an average day, how frequently do you apply over-the-counter lubricants?

(Includes OTC lubricant eye drops, gels and ointments, but excludes all other OTC drops such as allergy or redness relievers; excludes all prescription eye drops; excludes compounded and blood-derived eye drops)

Rebecca's observations: Numbers like this make me think of the reasons to use drops more frequently (prevention! getting ahead rather than catching up! don't wait till symptoms re-appear, use on a schedule!), and the reasons to use drops less frequently (is it about pain and sensation management or actual dryness? are there alternatives, ranging from consumer stuff like moisture chamber glasses to medical stuff like plugs? will too-frequent dropping make things worse for some people?)

QUESTION 2: On average, how many of the OTC lubricant drops (or gels or ointments) that you apply each day are PRESERVATIVE-FREE?

Rebecca's observations: Oooh, 4.6% aren't sure... great opportunities for education! A simple rule of thing is that all preservative-free lubricant drops SAY SO on the front of the box. If it does not say preservative-free, it isn't. But you can also check out our OTC ingredient guide. Known preservatives are highlighted.

Comments and Questions from Participants

Rebecca's comments in red

  • I utilize your drops for my prosthetic eye 4 times daily or more
  • I always use preservative free single vials, as I have an allergy to the commonest preservative in other eye drops. This is in UK
  • only gives momentary relief
  • Also wear scleral lens
  • I got an ulcer on my cornea from using OTC drops containing preservatives. That’s why I now only use preservative free.
  • I often use thick ones (optase) at night and thinner (soothe PF) in the morning.
  • Frequency of use varies a lot depending on environment.
  • They don’t seem to help at all
  • Have used Bion tears for over ~25yrs. Schirmer = 0mm (No tears!)
  • My eye doc said non-PF is okay as long as I don't use them more than a few times a day. [Yes. That is a generally accepted rule of thumb, although many people with moderate to severe dry eye are advised to avoid preservatives altogether. However, I would also like to point out that all preservatives are not equal. Most - but not all - lubricant drops have mild preservatives now compared to the past, but there are still lubricant drops on the market (particularly generic or obscure brands, but even some Bausch & Lomb drops) that contain benzalkonium chloride, also known as BAK. It never makes sense to use lubricants preserved with BAK.]
  • I wish the drop boxes could be purchased by the case instead of a couple of boxes at a time. [If you're referring to boxes of single-dose drops, can I suggest you look into preservative-free multi-dose bottles - more economical.]
  • Lubricants just make my lenses sticky. I find that I need to reset my lenses when I use lubricants so I try not to use them. [If you mean sclerals - or well any contacts actually - I feel exactly the same way. I occasionally drop a little saline on mine, though overdoing that can backfire. However I recently found myself liking Ivizia drops - the regular one, not the gel - for occasional use on my sclerals.]
  • You guys are great. [Haha so sweet, thank you!]
  • dry eye associated with Sjogrens
  • Yes
  • I have facial paralysis & don’t make tears [Hope you're aware of moisture chambers - this can be so helpful in exposed-cornea situations where lids aren't fully blinking by themselves.]
  • I have found that preservative free drops are almost totally ineffective for me. [Here's how I think about this: Just because an eye drop is preservative-free doesn't mean it's actually any good as a lubricant! Got to find the type of lubricant that is effective, then a preservative-free version of same in order to avoid cumulative toxicity from preservatives esp. if it's being used frequently. - Way back in the day, actually, I always used Dr. Holly's Drops, which were preserved back then with a very innovative very low toxicity preservative. The drops were so effective for me that I didn't have to use them anywhere near as often as other brands.]
  • I could never be anywhere without drops - or be in big, uncomfortable trouble. In addition to my “touchups” with these drops, I use autologous tears 2x daily at least and mix celluvisc in with Nutrifill
  • I need to keep a variety of types around
  • I only use when i feel its needed
  • Only use when inserting scleral lenses each morning, one or two drops inserted into each lens before filling with saline.
  • I was using about 4.5 vials of PF eyedrops per day, but then saw a eye dr. who said to only use 4-6 drops per day, as I was washing away my natural tears with all the drops I was using! I decreased to 4-6 drops per day and it has made a huge, positive difference. [Great advice. I know that doctors all have their own opinions, and we have to pick who we listen to, but this has always made good sense to me too. I think, again, that frequency of eye drop use is often prompted by comfort needs, not actual lubricant (i.e. corneal health) needs. We FEEL dry (or gritty or painful or sensitive or burning or whatever) therefore we drop. But constant dropping can perpetuate that. At least so I think :) ] And interestingly, this advice mirrors that I received about a year ago from a new dentist in the practice I use. He said I should not be sipping water all day for dry mouth issues, as that just washes away the natural saliva. Recommended Biotene spray instead. Again, a positive difference noted. [Oooh interesting!]
  • I only use in the morning and evening when my scleral lenses are out.
  • I wouldn't have know to only use PF drops if I hadn't joined the Dry Eye group. My eye doctors did not emphasize how important it is. Thank you Dry eye folks! [Woo hoo, we live for education :) ]
  • The answers I gave were based on my condition a year ago. Since then, I have been on Cequa cyclosporine prescription drops and my dry eye condition has been essentially cured. I used to go through 2 to 3 boxes of Thera Tears preservative free eye drops a month. Now I can go 2 or more months without having to purchase a new box and have switched to preserved bottles of artificial tears for the most part. After 40 years of suffering, a miracle cure! [WOW THAT'S FANTASTIC. We don't hear enough of these stories. Thank you so much for sharing!]
  • I use refresh tears and they are not preservative free, I believe only refresh plus is PF [Actually, Refresh brandhas six different preservative-free eye drop formulations - Refresh Plus, Refresh Celluvisc, Refresh Relieva, Refresh Optive, Refresh Optive Advanced and Refresh Optive Mega-3]
  • I use Systane gel at night. If there were a PF version, I'd use it. [I know right? No one has yet managed this. Have you tried the new Ivizia night time gel? I'm anxious to hear how Systane and Genteal gel users feel about it.]
  • I put one drop of Celluvisc in each lense before putting them on and also at bedtime before going to sleep. Rarely do I use OTC drops unless traveling and the air is really dry, like on an airplane. If I need additional moisture during the day, I prefer using saline rather than OTC drops.
  • On maintenane I use them 3-4 times a day.
  • In flares, I use them more than once an hour.
  • I credit Dry Eye Shop for educating me to use PF drops; my doctor mention PF casually but did not discuss. [Yay, that's what we're here for :) ]
  • Hi - For question 1, the amount I use of Preservative Free Blink individual vials varies each day. Sometimes 1-2x or 3-4x, it can change. A question: sometimes it seems like there is less solution in the most recent shipments of the Blink Preservative Free vials - the boxes say the same amount - is it possible that it can evaporate before being opened? Thank you for carrying Blink PF in vials, for the shipping reminders and for being a good resource! [It most definitely should not! Can I suggest you take pictures of vials so you can compare the level in them in case you need to get in touch with J&J about it? Personally, knowing a teensy bit about the manufacturing of these things, my best guess would be that some are over-filled, as opposed to some being under-filled. It happens. But as a regular user, you would know better. Don't hesitate to call Johnson & Johnson Consumer Eye Health at 800-347-5005 to ask them to look into it.]
  • Sometimes considerably more drops per day.
  • Thank you for asking. [Welcome! We love surveys :) ]
  • I have mild dry eyes
  • Refresh Celluvisc works the best for me, and I have to put it in every 7 minutes. [YIKES!. That's a lot. I'm curious whether your eye condition/circumstances are such that scleral lenses might be a possibility to look into?] I ruined my eyes because I used eye drops with preservatives in all of the time. Dry eyes kept getting worse until I found out that they should not be used more than 4 times a day. [So very sorry!]
  • I use PF Alaway(during allergy season) & PF Refresh. To bad the Dry Eye Shop doesn't accept the manufacturer coupons as it's already slightly pricier than getting them at the chain. The chain store is also more convenient as I order my supplies from The Dry Eye Shop for 2-3 months at a time and just never know how much I would need in that time frame and don't want to stock up on Eye drops like I do storage and cleaning supplies. It also helps my local grocery chain to keep the par quantity up if I buy on a regular basis from them as they do not stock many PF drops. The pharmacist had been very helpful in keeping them on the shelve and asked how many a month I would use and requested extra. Since discussing my need with her they haven't ran out of my drops again. So at a customer service level I feel compelled to support her by buying the drops she makes sure to bring in. [That's awesome, love that they have been so helpful to you and that you're giving them your business :) Just want to mention for everyone's benefit... we actually do honor manufacturer coupons when asked - just order by phone and let us know what you've got. I mean, we're not a pharmacy so we don't get a rebate or anything but always happy to honor a coupon anyway.]
  • I have used an infrared eye mask 20 minutes a day which has reduced drops needed to one or none a day [Awesome!]
  • sometimes at night I use optase eye gel.
  • My eyes do not make tears, as a result of GVHD. My favorite drop is GenTeal tears, along with Saline solution. I wear Scleral lens, but still have to keep adding moisture. Often the inside of my lids feel dry. I’d like to know of other drops that people with my condition are using successfully. [Have you tried any drops with sodium hyaluronate? They're available in a variety of price ranges, about $12 to $30. One that I particularly like the feel of is Systane Hydration.]
  • I would use OTC PF drops more often if I were not using autologous serum tears and scleral lens.
  • Have always used Refresh products and continue to do so
  • OTC eye drops don’t really give me relief. I could use them every 5 minutes some days…sadly. [Sorry to hear that but I hope something else is giving you some relief!] 
  • Mm a fan of Oasis and the new nighttime ivizia gel [I like the Ivizia gel too. We heat our tinyhome with a woodstove and it gets very dry overnight... I use the gel first thing in the morning.]
  • OTC drops have not ever helped me so I gave up on them after 10+ years of use. [Makes sense to not use what doesn't work!]
  • I have tried them all and Oasis preservative free is a winner...very long lasting. I insert a drop in the bowl of the lens and then add saline and have comfort all day! I can even do that with my soft lenses that I wear from time to time.
  • Try a variety of brands! Only 1 brand works for me the rest make eye discomfort worse! [Such an overlooked thing. Ingredients matter a lot!]
  • I love the new Ivizia gel drops, lid cleaner and liquid drops!
  • I am including organic, hexane-free castor oil in this group. I use a little in my eyes before sleep. Ever since I began using Honey Manuka drops last year I have been mostly pain-free and have been able to dramatically reduce the amount of lubricants that I use. [Fantastic!]
  • What is the best eye drop for severe dry eye and what is a difference between eye drops in chemical composition? [My opinion... best = the one that works best for you. It's so complicated, because it's not just about simple lubrication - like best oil for our car engine - it's about sensation, and tolerances, and sensitivities. The drop needs to both relieve symptoms and feel good, and we all have our different responses. I stand by this because I know so many people for whom only one thing works well... but it's a different one for each. Now, having said all that, from a technical standpoint, I believe that drops with high molecular weight sodium hyaluronate tend to be more effective than other drops (that's Oasis and Optase brands, for starters). I'd encourage you though to explore our Ingredient Guide.
  • Please discuss the various eye drops by active ingredients. What makes the difference between sodium chloride hypertonicity and other drops? [I'm going to have to save a longer discussion for another day - thank you for asking, I am definitely putting this on my to-do list. There was a really good article some years back in one of the optometry journals about this and I can't seem to immediately track down the link. For the moment though I want to mention two things: 1) hypertonic eye drops/ointment are not designed for lubrication, they are for corneal edema, and they are also often recommended for people with RCE (recurrent corneal erosions) from ABMD or other causes. 2) Check out our ingredient guide if you haven't already. - Again thanks, and I promise to come back to this.]
  • I found out the hard way that Retaine MGD has a BAK derivative in it. Beware of hidden BAK. [Hm. Have you reached out to the manufacturer, Ocusoft, to clarify what the ingredient is, and what its concentration is, and whether it's actually a preservative?]
  • Why can’t xiidra be affordable for patients on Medicare? [Novartis says that 70% of medicare patients are now covered for Xiidra. Here's their page on Xiidra cost managementfor what it's worth.
  • I only use once every 2 weeks. [Cool]
  • I am one year in with sclerals and developed pinguecula, I have dry eyes and I am noticing more mucus. I recently switched jobs so I am staring at a computer all day 7-12 hour days. What drops are best? So far I bought the reusable pf Refresh for convenience, but it seems to create a film..possible the glycerin? Is there a reusable container better for this situation? [Before tackling the drops can I make a suggestion about dealing with the extra computer use: 1) blinkingmatters.com2) Screen position - make sure you are looking either straight or slightly downwards, never upwards, as you'll have more exposure and tear loss 3) maybe consider moisture chamber glasses like zienas for during computer use? 4) personally i have a little hygrometer at my desk and when it dips below 45% I turn on a Levoit desktop humidifier. Re drops: Are you talking about drops for use on top of your lenses? Personally I have very low tolerance for drops on my sclerals. Refresh Plus *maybe*. Ivizia drops, as long as it's not frequent. In general, I'd look for low concentration carboxymethylellulose or polyvinyl alcohol and/or povidone, as opposed to glycerin based, definitely avoid anything with any oils too. Check out our ingredient ref list.
  • ophthalmologist recommended PF for scleral lenses
  • Is there a summary of the active ingredients in OTC preservative-free drops? [Yes,herebut don't forget the inactives, sometimes there can be a pH buffer lurking in there that someone has, or develops a sensitivity to] At this point I seem to be able to tolerate only Genteal. I would like to figure out what is causing my reaction (burning) to all the other brands I have tried, or alternatively find out what other brands are most like Genteal. My eyelid is starting to be irritated in the evenings, so I am wondering if I am now becoming sensitized to the Genteal drops. [It definitely happens. Have heard from many people who have become sensitive to Genteal Gel as well.] Most evenings I have to hold a cold compress to my eye to be able to watch tv, and then finally just put in the Refresh PM ointment, put on my TranquileEyes goggles, and go to bed. Thanks!
  • Even with Preservative Free eye drops, there are still all kind of ingredients that can irritate my eyes. I really wish they'd make PF vials with simple ingredients: water, saline, glycerin. That's it! [I hear you! Then the next problem becomes the pH - often some of those extra ingredients are all about adjusting the pH to the level of the eye so that the acidity does not also become an irritant. Are you familiar with Optase brand - they're very good about keeping that ingredient list short, at least for Dry Eye Intense and the dry eye spray, not necessarily MGD. Ooooh I just came across another short-lister: Refresh Classic.]
  • I use prescription eye drops 2x daily
  • I am a cornea transplant patient and I use scleral lens.
  • Is there no cure for dry eyes, just modest symptom relief? [No simple answer to that because "dry eye" is not a disease, it's a big bucket of a lot of different conditions, some of which truly are chronic in nature. In many situations the primary goal is managing symptoms and reducing impact on quality of life.]
  • They have no staying power
  • WIth scleral lenses, I need way fewer OTC drops [Yay!]
  • Optase MGD dry eye drops and dry eye intense drops are great. They are preservative free and in one bottle which makes it easier than having a big box with individual drops. [Totally agree, I love these too, and I'm looking forward to the day when most drops will be in these MDPF bottles.]
  • ...Just that I appreciate your product analysis & data very, very much - it has improved my life =) [So glad, thank you!]
  • Does Genteal Severe Nighttime Gel have a preservative? [Yes. However, it's a special kind of preservative that is often referred to as a dissipating preservative - that is, the preservative 'disappears' on contact with the eye, so you might see it described as "preservative free on the eye". (This is also true for Systane Gel.) There are some limitations to how that works on a very dry eye though, and people do sometimes report finding it irritating.]
  • only use drops during sleep hours
  • Severe KCS (Schirmer = 0mm; No tears) due to MCTD, Secondary Sjogren's, Severe Sicca Syndrome); Have used Bion tears for over 25 years.
  • Not many good ones to use when I wake up which matters the most
  • I use Thera Tears "Extra" OTC eye drops.
  • preservative free has never been a concern of mine
  • I use Evo tears 2-3 times a day, and HA drops otherwise as they don’t gunk up my lashes. I order Hylo drops from EBay or Amazon usually since they are still not aporoved in the US.
  • I'm grateful for Refresh.
  • Occasionally my lens cloud
  • I also add 2 drops of Systan PF to my Sclera lens in the morning.
  • I u see to use eye drops many many times a day until I purchased eye seals. They have helped me immensely [Great to hear. Physical barrier protection over the eyes at night to increase moisture can really help a lot of people.]
  • How important is it to use preservative free drops? [Depends on the person, depends on the preservative, and depends on the frequency of application. Some people have sensitivities to all preservatives of specific preservatives. Some preservatives are relatively mild - the one of biggest concern is benzalkonium chloride (BAK) which is common in prescription eyedrops but thankfully now rare in OTC lubricant drops - however it's still present in redness relievers (including Lumify) and allergy drops that are sold OTC so that can really be a concern. Read more here. For any preservative, frequency of application is the main concern. Many eye doctors will suggest, as a rule of thumb, that if you use drops more than 4x daily, it should be preservative free. However, many doctors who deal mostly with dry eye recommend only preservative free drops.] What about the drops while using scleral lenses? [Assuming you mean drops "over the top", in some ways it's less of a concern because they're probably not reaching the cornea at all. Personally, I think it's always best to be PF, and now that there are preservative free bottles with filters to keep them sterile, it's just as convenient as conventional preserved drops.]
  • I'm grateful to have them. They make my eyes much more comfortable!


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