Making Sense of OTC Eye Drops

The eye drop aisle at your local pharmacy can be scary and confusing. There are 5 shelves and they all say "lubricant." How do you know what to choose? Before we begin, I have no financial interest in these products, but would LOVE to have some financial interest. Let me know if you have some, I have a lot of student loans to pay off.

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The first thing you'll notice is that every pharmacy is having an eye drop fire sale year round.

BUY 1 GET 1 50% OFF!!

BUY AN ENTIRE SHELF OF EYE DROPS, GET A STANDING OVATION BY OUR CASHIERS!!

Before loading up on artificial tears like a doomsday prepper, let's do a little math...

The average OTC bottle contains 10 ml of fluid. The average individual drop measures 0.05 ml, so in a 10 ml bottle you get around 100 drops. Also, 0.05 ml is PLENTY of fluid for the ocular surface, so you only need one drop each time you use the bottle. In fact, your eye can't even handle that volume and you end up wiping away some of it. With liberal application of artificial tears 4 times per day, one bottle should last you about a month. The vast majority of people don't need to use artificial tears chronically, so hold off on scooping up an armful of Refresh and dropping $60. If you find yourself using OTC drops more frequently and for longer than a month, go see an eye doctor please.

Another reason not to buy a bunch of tears all at once is that every bottle has preservatives, and some people develop allergies to different preservatives. If one brand doesn't agree with you, move on to another brand. If none of the brands agree with you, stick with preservative-free drops. If preservative free drops don't agree with you, maybe you just weren't meant to have eyeballs.

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Now, a quick word about brand vs generic. They both have the same active ingredients, but different preservatives which are not listed. I've found generic preservatives to induce more allergy than name brand preservatives. Generic is still a good option, but stick with brands if you can afford it.

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Refresh and Systane, royalty in artificial tear land, the most boring fictional land out of all the fictional lands. You won't go wrong with these two. As an added benefit that only an ophthalmologist can get excited about, they come in 15 ml bottles (150 doses, what a deal!!).

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Blink and Thera Tears are also good options. One provides immediate comfort, the other immediate, long lasting relief. One of them also drains into the subarachnoid space, directly stimulating your pleasure center causing a level of euphoria unmatched by modern pharmaceuticals. Not sure which one though.

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Stay away from Visine and Clear Eyes. Look at all the garbage in Visine. It has ASTRINGENT, the thing you use to get rid of pimples. I wouldn't want that in my eyes. Visine is strictly for stoned teenagers trying to fool their parents. Also, didn't your mother tell you to stay away from Tetrahydrozoline? No? Just me? 

Clear Eyes is slightly less offensive, but if you have red eyes, THERE IS A REASON. Your conjunctival and episcleral vessels are dilated, delivering inflammatory mediators to the ocular surface and making you feel fucking miserable. Actually no, a bad cold makes you miserable. Red eyes just make you feel really really irritated and frustrated. Using Visine and Clear Eyes constricts those blood vessels, but you are ignoring the reason those vessels are dilated in the first place. Once the vasoconstriction wears off, the redness and irritation comes roaring back. Good for Visine, bad for you. If you have irritated, red eyes, go to the eye doctor to find out why.

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Don't be fooled by Visine's marketing campaign. It's just varying degrees of bullshit. 

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For allergy relief, stick with Ketotifen (brand name Zaditor or Alaway). Naphcon is just Visine with a shittier name. OTC allergy drops may not be sufficient for people who get murdered by pollen every year. If that describes you, come see me, I have wonderful things to prescribe you.

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If regular old artificial tears aren't cutting it and you want longer relief, you need something thicker. Celluvisc is my favorite and its preservative free. It also has a name that just screams happy, moisturized eyes. It blurs up the vision for a few minutes after you put it in. 

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Finally, the nighttime gels and ointments. Lube up those lookingballs before bed, especially if you wear a CPAP or tend to wake up in the morning with your eyes feeling like sandpaper. You won't be able to see anything and might fracture a hip getting to the bathroom in the middle of the night, but your eyes will feel great!