OTCs Today
Mary Warner
For those with dry, itchy, red, or irritated eyes, nonprescription eyedrops can provide fast and inexpensive, but short-term, relief. A typical pharmacy shelf may contain over 50 different products designed to soothe the eyes, so it’s important to understand which will provide the most effective relief.
Dry eye relief
Eyedrops are specifically formulated to treat different symptoms, with discomfort associated with dry eye disease ranking as the most common condition for which nonprescription eyedrops are used. Dry eye disease is most often caused by wind, smoke, reduced tear production, or extended use of a computer screen. Recent data show that in the United States, dry eye disease may affect as many as 5 million people, especially those 50 years and older.
Drops formulated as artificial tears to treat dry eye disease contain preservatives, inorganic electrolytes to achieve tonicity and maintain pH, and water-soluble polymeric systems. All artificial tear eyedrops provide ocular lubrication, but buffering agents, preservatives, pH, and other formulation components vary among products. Common ingredients include carboxymethylcellulose sodium, povidone, hydroxypropyl methylcellulose, glycerin, propylene glycol, and mineral oil.
Formulations without preservatives are less likely than those with preservatives to irritate the ocular surface. However, patients should be aware that preservative-free products should be discarded immediately after being opened and used to avoid contamination and possible infection if used again.
Examples of artificial tears include Systane Lubricant Eye Drops, TheraTears, Visine Dry Eye Relief, and Refresh Relieva.
Red and itchy eye treatment
Eyedrops intended to “get the red out” contain a decongestant—usually tetrahydrozoline or naphazoline—to constrict the superficial blood vessels in the eye. They’re intended to be used only on an as-needed and short-term basis, as longer-term use can worsen dry eye symptoms and cause rebound hyperemia when the effects wear off. Examples of eye drops intended to relieve red eyes include Lumify Redness Reliever, Visine Redness Relief, Clear Eyes Redness Relief, and Bausch & Lomb Maximum Redness Reliever.
Itchy eyes from allergies can be treated with eye drops that contain an antihistamine and a decongestant to reduce redness, irritation, and itchiness. These are most effective at controlling symptoms from pet dander, pollen, and dust and should be used only as needed. Examples of itchy eye relief products include Visine Allergy Relief, Clear Eyes Maximum Itchy Eye Relief, and Bausch & Lomb Alaway Allergy Eye Itch Relief.
Eye washes can also be used to control itching and irritation from allergies; they also remove foreign particles, such as air pollutants and pollen, from the eyes. They contain primarily sterile water with a preservative to prevent contamination. Using an eye wash daily can sometimes alleviate the need for mediated eye drops. Examples of these products include Bausch & Lomb Eye Wash, Systane Eye Wash, and Optrex Eye Wash.
Safety concerns
Under the Federal Food, Drug, and Cosmetic Act, eye drops must be sterile to be safe for use. Unfortunately, however, this is not always the case, and several brands of OTC eye drops have been pulled from pharmacy shelves this year after they were found to contain drug-resistant bacteria.
In January 2023, FDA warned against using EzriCare Artificial Tears and Delsam Pharma’s Artificial Tears because of possible contamination with Pseudomonas aeruginosa. Then in August 2023, FDA told consumers to immediately stop using Dr. Berne’s MSM Drops 5% Solution and LightEyez MSM Eye Drops–Eye Repair due to possible bacterial contamination, fungal contamination, or both. Contaminants found in the products include Bacillus, Pseudomonas, Mycobacterium, Mycolicibacterium, and Methylorubrum bacterial species, as well as Exophiala fungal species.
These products also contain methylsulfonylmethane as an active ingredient, though it hasn’t been approved for use in ophthalmic medications in the United States.
FDA warned that use of contaminated eye drops could result in minor to serious vision-threatening infections which could possibly progress to a life-threatening infection, and CDC said that anyone who used these products and has symptoms of an eye infection—including yellow, green, or clear discharge from the eye; redness of the eye or eyelid; increased sensitivity to light; and eye pain or discomfort—should see a doctor immediately.
What to tell your patients
Ensure that patients understand that while artificial tears can be used several times daily (most often in the morning and before bed), medicated eyedrops that contain a decongestant or antihistamine should be used only as needed. Most nonprescription eye drops are inexpensive and provide fast relief, but the relief is short-term, and patients with chronic problems should see their ophthalmologist to rule out more serious eye conditions. ■