#350 Not a Dry Eye in the House – Looking into Artificial Tears

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- Two systematic reviews with 43-64 randomized controlled trials (RCTs) reviewed individually for patient-oriented outcomes. Most excluded post-surgical and contact lens wearers.1,2
- Artificial tears versus “placebo”/no-treatment:
- RCT (304 patients): Symptoms like dryness/soreness (scale 0-15, higher worse, baseline ~8).3
- At 28 days: 5.7 sodium hyaluronate versus 6.1 saline drops, statistically but not clinically different.
- RCT (27 computer-users, many without dry eyes) compared three different artificial tears to ‘no product’.4
- All interventions, including ‘no product,’ reduced patient symptoms, without difference between groups.
- RCT (304 patients): Symptoms like dryness/soreness (scale 0-15, higher worse, baseline ~8).3
- Artificial tears versus each other:
- Validated patient symptom scale (0-100, higher worse, minimal clinically important difference=4.5): 18 RCTs; 27-445 patients with moderate-severe dry eyes. Of 36 different comparisons,1,2 three were statistically different:
- Industry funded RCT (40 patients): At 90 days, cross-linked hyaluronic acid/coenzyme Q10 combination improved 16 points versus 8 points for hyaluronic acid alone.5
- RCT (110 patients): At 30 days, final scores differed by 3 points (biased by differing baselines).6
- RCT (120 patients): 12-week scores for sterile isotonic seawater washes were 4.5 points better than carmellose drops.7
- Other patient-oriented symptom scores, 6 RCTs with ≥100 patients.3,8-12 One statistically different:
- 135 patients, hypotonic 0.4% hyaluronic acid versus 0.3% hydroxypropylmethylcellulose. Example: Proportion attaining ‘mild or resolved’ burning or foreign body sensation at 60 days: 19%-36% more patients on hyaluronic acid.10
- Validated patient symptom scale (0-100, higher worse, minimal clinically important difference=4.5): 18 RCTs; 27-445 patients with moderate-severe dry eyes. Of 36 different comparisons,1,2 three were statistically different:
- Preservative versus preservative-free artificial tears:
- Systematic review (2 RCTs, 271 patients): No difference.13
- Artificial tears versus “placebo”/no-treatment:
- Limitations: High risk of funding bias,5,10 chance findings (many RCTs, differences rare), and some biased analyses.6,10
- Over-the-counter product costs vary (<$10 to >$50) with preservative-free typically being more expensive.14
- Guideline recommends preservative-free products if intolerant to preservative, soft/hybrid contact lens wearers, use of other eye topicals with preservative, or if drops required ≥4 times/day.15
- Non-topical interventions include warm compresses and lid hygiene.16