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Preservative awareness, June 2022 updateUpdated a year ago


May 9 to June 6, 2022




General questions

I consider my dry eyes to be...

The vast majority (93%) of participants in this survey have moderate to severe dry eye.

I would say my knowledge of preservatives in eye drops is...

PROGRESS! Compared to three years ago, the number of participants who have limited or no knowledge of preservatives shrunk from 21% to 14%. 

Section 2: Over-the-counter lubricant eye drops

How often do you use artificial tears (lubricant eye drops) and which package types?

  • 45%: I only use preservative-free drops because I believe preservatives are toxic and could make my dry eyes worse.
  • 8%: I use what my doctor recommends, but I don't necessarily know if it has preservatives.
  • 29%: I only use preservative-free drops because I believe that I'm allergic to preservatives or that they bother my eyes.
  • 3%: I use what my doctor recommends, even if I know it has preservatives.
  • 5%: I use bottled drops because preservative-free vials are too expensive.
  • 20%: I believe some preservatives are worse than others.
  • 30%: I only use preservative-free drops because those are my doctor's instructions.
  • 32%: I only purchase drops that come in single-use vials.
  • 2%: The eyedrop I prefer (or that my doctor prefers) is not available preservative-free.
  • 9%: I use bottled drops with preservatives for convenience.

Section 4: Other OTC drops - allergy drops, redness relievers

How often do you use non-prescription eye drops for REDNESS relief and/or ALLERGY symptom relief?

For those who do, is your eye doctor involved in your choice of these types of eye drops?

Section 3: Prescription eye drops

  • 11%: I am using one or more prescription eyedrops but I don't know whether they are preserved.
  • 11%: I am using one or more prescription eye drops that I believe are preserved, but I don't know which preservative they have.
  • 26%: I am using one or more prescription eye drops that are preservative-free.
  • 4%: I am using one or more prescription eye drops that are preserved (but not with BAK).
  • 5%: I am using one or more prescription eye drops that are preserved with BAK.
  • 8%: I am using one or more prescription eye drops that are not available preservative-free.
  • 10%: I am using specially compounded eye drops because I want/need them to be preservative-free.
  • 8%: My doctor and I have discussed the risks of preservatives in my prescription eye drops.

Comments (and Rebecca's responses)

  • I am somewhat concerned that I don’t know more about the different types of preservatives in eye drops, so I am trying only preservative-free ones (as I suspect I will be using eyedrops for many years and may perhaps need to increase the number of drops per day over time)
  • Please take the lanolin out of Systane PF nighttime ointment. The previous formula had the perfect balance of petroleum and mineral oil for my dry eyes. Soothe ointment and Retaine PM are the only lanolin-free lubricating ointments we are aware of at this time.
  • Products that contain wool alcohols irritate my skin and REALLY affect my eyes in a bad way. See above
  • The way that the preservative free multi dose drop bottles are designed makes it hard to get the last 1/3 out of the bottle. I wish someone could come up with a way to move the bottom of the bottle up instead of compressing the sides.
  • I have had no support from my glaucoma docs in tryin go switch. I changed cornea docs who immediately changed all my glaucoma drops to get me off preservatives. He was willing to do this prior to consulting my glaucoma doc. My pressure is lower than it has ever been and both docs have documented a difference.
  • I would use the individual vials more frequently but I have accidentally stabbed myself in the eye with them several times so I try not to use them. The multi-dose preservative free bottles are a good option in that regard because they are flat-topped.
  • I wish there was an overnight dry eye relief that didn't contain mineral oil or petrolatum because I'm allergic to those chemicals. Consider a polymer gel like Genteal Gel? and/or moisture goggle or shield?
  • I feel like I need allergy eye drops. I recently started wearing scleral contacts and am not familiar enough with the allergy drops to know which one to use now that I'm wearing contacts. This would be a great conversation to have with your eye doctor. Several formerly prescription-only allergy drops are now available OTC. There is just one OTC drop which (finally) became available preservative-free (Alaway PF).
  • Wish there were affordable (non preserved) alternatives in RX drops. Amen to that.
  • wondering why BAK is allowed if it is so toxic to our eyes It's because it's so good at what it does (preventing bacterial contamination) and in prescription drops that are taken only for a short period, it is not generally considered a problem. There has been a gradual trend towards PF options but it will take time. Another factor is that for some medications, BAK is considered to improve drug penetration into the eye. Keep an eye out for a presentation the Dry Eye Foundation is going to be publishing soon about how preservatives work.
  • My first eye doctor told me to use a specific eye drop when I started getting dry eye from GVHD. Soon after, I got an ulcer on my cornea from too much preservatives. Most painful experience ever! Terrified of preservatives now!!
  • Preservatives irritate my eyes.
  • It would be great to know about preservatives in allergy drops, especially the newer brands that have come on the market. You may find this resource helpful: https://www.dryeyezone.com/eye-drops-preserved-with-bak
  • Found out a number of years ago from an optometrist that preservatives in eye drops made my eyes worse.
  • Wish the prices would be more cost effective; they are so expensive! The PF bottles are the most economical option
  • Do you know if/when Lumify will be available preservative free? No but they have promised it's coming!
  • I had a situation some years ago with Restatsis. The company claimed it was preservative free. After using it just for days, I could hardly open my eyes they hurt so. I found out later there was actually a preservative in Restatsis, but they did not call it out. I hope that situation has changed, where companies do need to call out any type of preservative. I don't feel this is correct. I would love to hear more details. It's definitely possible to have a reaction to the vehicle or the drug. This should be reported to the FDA as an adverse event.
  • So sorry I was given glaucoma eye drops containing preservatives which led to my dry eye problem.
  • My doctor has given me answers to my questions and suggestions on PF drops, ointments, compresses, lid scrubs and environmental hints to help with my dry eye issues and they are working. She also gave me your website address.
  • Interested in whether Cequa has preservatives No, it does not
  • I started using preservative-free eye drops at my doctor's recommendation, but I disliked the environmentally unfriendly multiple small plastic vials. If they came in glass or aluminum vials, I'd be more likely to continue. As it is, I choose the larger single plastic bottle (whether or not it's preservative-free) to have less impact on the environment. I agree about the environment, and I would encourage you to use the PF bottles as the impact of preservatives on your eyes matters too.
  • I've been using Refresh Plus individual dose vials but now the drops are irritating my eyes. I fear I've developed an allergy to Carboxymethylcellulose and now looking for a drop without this ingredient. Try the following link - you can search there for drops without CMC. https://www.dryeyezone.com/lubricant-eye-drop-reference
  • I use preservative free eyedrops most of the time. I occasionally use drops with preservatives, but I never use drops with BAK because I did at one time and they definitely made my dry eyes worse. As soon as I stopped using BAK drops my eyes started getting better.
  • People need to be more aware of preservatives in eyedrops and all eyedrops should offer a preservative free option.
  • How do I know which preservatives are ok to use? This is a great conversation to have with your doctor. Frequency of exposure is a key factor, as well as how toxic the preservative it is. Daily long-term use of the most toxic preservatives is definitely to be avoided where possible.
  • When I started wearing Scleral Lenses, Dry Eye reduced dramatically
  • I never thought whether iidra drops are preserved or not They are not
  • I always use preservative free eye drops and eye ointment at night.
  • I only use OTC drops all preservative free! Per my physician and he has always been correct!!!
  • Thank you! I appreciate all the resources about preservatives.
  • I have severe chronic allergic conjunctivitis, made worse by dry eye and ocular rosacea. I used BAK-containing ointments/drops/gels unknowingly until I had a serious reaction. Then I found your information on preservatives and it helped me isolate the cause of my reaction. I had been using allergy drops preserved with BAK for years! My allergic symptoms worsened so I thought my drops were just less effective. So I kept increasing the dosage until I maxed that out and was still having serious allergic problems. I still cannot use anything persevered with BAK, even items that aren’t eye drops (found it in a nasal spray, for example). Wow. So sorry to hear that!
  • The problem was these things would initially provide allergy relief, but after 10 minutes I would feel worse so it was difficult to associate BAK as the problem. And then I would have to take Benadryl, and be incapacitated all day.
  • Anyhow, I wish more information was shared about BAK. I don’t like how many prescription eyes products contain this preservative- makes me feel a bit nervous for the future if I ever require such items. What am I going to do? Thankfully there is more and more BAK awareness and better PF options or options with milder preservatives are gradually rolling out. 
  • I'm in Australia, periodically I need antibiotic and steroid drops for corneal ulcers and those drops are not available in preservative free formulation here.
  • All eye drops seem to make my eyes dryer.
  • Interested in preservative free redness drops. Lumify is supposed to become available PF, hopefully this year.
  • I eliminated items with preservatives to see if it would help. It has not completely solved the problem, but it also hasn't made things worse. Occasionally I do have to use a steroid drop when I have a flare, but to be honest the steroids don't help much either. I believe they have a small amount of preservative.
  • I've learned a lot from the Dry Eye Shop videos and Facebook groups
  • Would like to learn more
  • Don’t use them….I’m sure they made my dry eye worse.
  • why are they used anymore anyway? Because of bacterial contamination risk. Please click to see this video for more information.
  • 2 drop of Systane PF inside the scleral then fill with Nutrifill
  • They are bad news for dry eyes. Avoid them.
  • I think it's worth the extra cost to buy preservative free drops because my eyes are very important.
  • My doc recommended Refresh Optive for wetting drops throughout the day. That is what I use. And I use Refresh Celluvisc for adding to my insertion saline.
  • dry eye medications are ridiculously expensive - i can't afford them.
  • Sometimes there is no choice like Muro 128
  • Not a concern but gratitude: Your info & listings re: eye drop ingredients is the only one of its kind online AFAIK (meaning, independent: comprehensive + not selling any product +not affiliated with any eyecare office or manufacturer) and I'm extremely grateful I am for it! I mention it in every eye care office I visit, and wish I had more effective ways to "evangelize" about it... thank you so much for all you do. Thank you, we appreciate your very kind feedback!
  • Thank you for carrying preservative-free individual vial drops and for the information and research you provide!
  • I find my restasis or xiidra drops feel better once my scleral has been off my eye for a few minutes, rather than immediately after I remove it.
  • I'm not certain how harmful preservatives can be to overall eye health, but I can definitely tell a negative difference in how my eyes feel (over time, not immediately) when using drops that contain preservatives.
  • I wish there was no BAK in Bausch & Lomb eye wash! Consider calling and telling them so: 1-800-553-5340
  • For a long time I was using allergy eye drops. Rx and otc. They had bak. I wish there were choices of allergy drops that were preservative free. There is one! Alaway PF, available OTC.
  • The cornea specialist told me not to worry about the preservatives! Click here for an articleyou may want to share with your cornea specialist.
  • I use single vial tears as my dry eyes are severe and have to put tears in up to 9 times a day
  • Taken off glaucoma eye drops due to bak. Insurance is not proviving for presercative free glaucoma eye drop. Glaucoma is being monitored closely but I am still concerned.
  • Preservative eye drops dry my eye even more affecting my vision.
  • I recently showed my doctor a bottle of Optase which I had just tried and loved. He didn't understand why a preservative free drop didn't need refrigeration. I told him that I'd used Purilens for years and that it was preservative free and didn't need refrigerating. He was puzzled so I told him to call you (he was familiar with your company) for an explanation. I look forward to the call. Optase and Purilens are very different, just for perspective. Optase (and many others) have special technology to prevent contamination of the bottle, using springs and filters. Purilens is potentially subject to contamination after opening, in fact there was a study published about this. I recommend watchingthe video at this link.
  • I use preservative free Refresh Relieva PF in a bottle because single use vials waste too much. Excess drops simply run down the face making the drops too expensive.
  • For allergies, my eye doctor recommended Alaway which contains BAK. Previously, I tried other eye drops for allergies without any relief from allergic symptoms. I rarely use this eye drop; so, there should be little harm. Alaway is now available in preservative-free form in drugstores! Look for Alaway PF.
  • For almost 40 years I used eyedrops for allergy that had preservatives and am convinced that long term use caused my dry eye and meibomian gland dysfunction.
  • Would like to see more preservative free eye medications available. Lotemax Gel, AzaSite.
  • I also look buffering agents in over the counter drops
  • Alaway now has preservative free vials!
  • I would like to ow if Restasis is PF. Yes
  • This says optional, but is actually required! SORRY!
  • I will never buy again. This package sucks. Sorry to hear that. Which one?
  • Have experienced reactions to preservatives in past!
  • Hope I never have to use a prescription eye drop (glaucoma) with preservatives.
  • I am using standard Dorzolamide HCl/Timolol Maleate because of price.
  • I think (strictly my own thought, not actually based on medical advice) that occasional/rare use of drops with preservatives is unlikely to harm most people. But I’d think that people who have any sort of medical issue with their eyes (presumably most if not all of your customers) should exercise common sense and check with their eye doctor. Oh certainly, occasional uses and short courses are not generally considered a problem. Preservatives cause issues through frequency of exposure.
  • I am very allergic to BAK unfortunately
  • I avoid preservatives because I have enough eye problems due to Sjogren’s and MGD.
  • At my doctor's suggestions, I am now using Oasis Tears preservative-free eye drops. I find them quite comfortable and soothing, but too expensive.
  • I wish there was more information about this and that non-preservative eye drops were more accessible! Check outthis video, this article and this ingredient guide.
  • Would love to know more about the different preservatives in prescription eye drops. OTC is easy to figure out due to the labeling. See links immediately above
  • I had a horrible reaction to Xidra drops. Are there preservatives in them? No there are not
  • Optanol has preservative but was recommended as the best drop. I’m on it for half a year at a time so it concerns me but I try not to worry.
  • Thank goodness for the facebook site that you sponsor that helps educate all those people that don't get educated in their physician's office!! Thank you :) 


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