Ocular lubricants (artificial tears)

Key examples

• Hypromellose
• Carbomers
• Liquid and white soft paraffin

 

Common indications

• For first-line symptomatic treatment of dry eye conditions including keratoconjunctivitis sicca and Sjögren’s syndrome, alongside environmental coping strategies and avoiding precipitants.

 

Mechanisms of action

• In dry eye conditions, ocular lubricants have a soothing effect and help protect the eye surfaces from abrasive damage. Lubricant eye drops typically consist of an electrolyte solution with a viscosity agent, such as a cellulose polymer (e.g. hypromellose). Gels, such as carbomer 980 (the active ingredient of Viscotears®), have greater viscosity and are retained in the eye for longer. Ointments such as white soft paraffin with liquid paraffin (e.g. Lacri-Lube®) are highly viscous and may provide greater protection, but at a cost of causing blurred vision.

 

Important adverse effects

• Ocular lubricants have few side effects other than mild stinging on application and temporary blurring of vision. The risk of blurring increases with viscosity and is therefore greatest for ointments. Unless specified as ‘preservative-free,’ it can be assumed that the preparation contains some form of preservative. This may incite a local inflammatory (allergic) reaction in some patients.

 

Warnings

• As ocular lubricants are not absorbed, there are no major safety considerations from a systemic illness perspective.

 

Important interactions 

• There are no clinically important interactions.