Eye Drops Explained

By Burt Dubow, OD

Questions about eye drops or ointments are among the most commonly asked in my practice.

If you've ever looked at the large display in any pharmacy or discount outlet, you've likely noticed the confusing array of what we call over-the-counter (OTC) eye drops. OTC means you can buy these eye drops without a doctor's prescription.

To add to the potential confusion, many prescription (Rx) eye drops and ointments can be obtained from a pharmacy only when specifically prescribed by a doctor.

Determining which kind of eye drop or ointment is best usually depends on what kind of eye condition you have, such as dryness, itching, swelling, redness, soreness, mattering (eye goop), allergies or infection.

When Are OTC and Prescription Eye Drops Needed?

Let's look at common reasons for needing eye drops or ointments. Then I can help you figure out whether you can get by with OTC relief, or if you might need to see an eye doctor for an Rx. We'll explore types of eye drops that might be needed for:

• Dryness
• Redness
• Itching
• Allergies
• Soreness
• Swelling
• Mattering (Eye Discharge)
• Infection

Of course, when you have an infection or if any of these symptoms are severe, it's always best to consult your eye doctor.

Eye Drops for Dry Eyes

Many ordinary OTC eye drops can provide relief for short-term dry eyes, when the cause is related to temporary circumstances. In fact, temporary dry eye probably is one of the best reasons to use OTC lubricating eye drops for relief.

Probably everyone has dry eyes at one time or another. Your eyes can feel dry if you're very tired, if you've worked at the computer all day or if you've been reading for a long time.

Other reasons for dry eye include being outdoors in windy and sunny conditions. You can have dry eyes even if you spend too much time in an airplane, where the air is extraordinarily dry, or if you fail to drink enough water, which leads to dehydration.

Many OTC lubricating eye drops can give you some relief from short-term dryness. Most work by adding various tear elements that are in your eyes already, making them function better.

It's best to avoid a decongestant eye drop for dry eye, though. You'll recognize a decongestant eye drop because it's typically advertised as relief for red eyes. Decongestant eye drops work by shrinking the outer blood vessels in the white parts of your eyes (sclera), making them look less red. But decongestant eye drops also cause dryness.

Long-term dryness can happen with conditions associated with aging, especially with women (due to hormonal changes). Certain medications also can cause long-term dryness, such as decongestants, diuretics and antidepressants. So again, the type of eye drop you choose to relieve dryness is related to the underlying reason for eye discomfort.

If your dry eye problems are long-term, you may need a gel or ointment, available in preserved and non-preserved forms, for more relief.

Because gels can cause blurred vision for a while after you put them in your eyes, most people use them just before going to sleep. Some gels become liquid upon contact with the eye.

If you do choose to use a gel during the day, give yourself a few minutes for your vision to clear before you drive or do anything that requires good vision. Some OTC ointments can be used for more severe dryness during the day, but these really do cause blurred vision and usually should be reserved for overnight use while sleeping.

If OTC drops don't do the job, you may need to see an eye doctor for dry eye testing and additional treatment.

In more severe cases of dry eye, several Rx eye drops and ointments are available that your doctor can prescribe for longer-term relief.

Eye Drops for Redness

Red eyes can happen for many reasons: dryness, allergy, infection, tiredness or a combination of these factors. Rather than use decongestant eye drops, you should consult your eye doctor so that the underlying cause can be identified and addressed.

Decongestants shrink the blood vessels and make the eyes whiter. But they mask the problem, making it harder to figure out the cause. As mentioned above, decongestant eye drops cause dryness and irritation if used often, and they can be addictive. Your eyes can become dependent on the drops to stay white and clear, forcing you to use them more and more. And decongestants can sometimes cause your pupils to dilate.

If your eyes are red from tiredness, dryness, lack of sleep or general irritation, I suggest you try an OTC lubricating drop for relief. If your eyes are red from allergies, lubricating drops also can help considerably by washing what you're allergic to — such as pollen — out of your eyes.

Allergies, Eye Itching and Eye Drops

Itchiness almost always is a sign of allergy, so you may need a different approach when it comes to buying the right eye drops for this condition. Sometimes allergies can cause other eye symptoms such as swelling, redness, wateriness and puffy eyelids, for which OTC eye drops also may be useful.

Allergy symptoms such as itchy eyes can result from seasonal allergies (usually spring and fall) or if something you're allergic to gets in your eyes, including a chemical or foreign substance.

Rubbing itchy eyes makes them red, irritated, puffy and sore because it causes a release of a chemical called histamine that's in the eye tissues. For this reason, rubbing eyes actually can make them itchier. But using certain types of eye drops for relief may help you resist the temptation to rub itchy eyes.

OTC antihistamine eye drops, such as Alaway or Zaditor, specifically are formulated to treat itching due to allergy by reducing histamine in the eye tissues.

Some decongestant eye drops for red eye also have antihistamines in them. They're labeled as treatments for itching due to allergy, but I don't recommend you use a decongestant eye drop long-term (see section on eye drops for redness above).

If the itching is severe and doesn't get better with OTC treatments, then it's best to see an eye doctor for Rx eye drops and oral medications.

Eye Drops for Soreness, Swelling or Discharge

Before you consider using eye drops for soreness, it's essential to determine the underlying cause.

Usually eyes become sore because they're dry, strained, tired or just plain overused. Rubbing can make your eyes feel worse in the long run, even though it feels good at first. But if your eyes are sore a lot, you should have an eye exam to see if your vision needs correcting for focusing problems related to farsightedness, nearsightedness, astigmatism or presbyopia.

Otherwise, dry eyes (see section above) probably are the most common reason for sore eyes, which may be relieved with lubricating drops.

Lubricating eye drops also may provide relief for eye irritation from visual stresses such as crying, eye discharge related to allergies and swelling from inflammation and allergies.

However, "mattering" or thick, yellowish eye discharge caused by an eye infection may require an Rx for antibiotic eye drops.

"Pink Eye" Infection and Eye Drops

The basic eye infections most people get are all called "pink eye."

A pink eye also can be a sign of different types of conjunctivitis such as bacterial conjunctivitis, viral conjunctivitis or allergic conjunctivitis. This can be confusing because — even though these various conjunctivitis types all have different causes — they're all called "pink eye."

If you are using a lubricating eye drop to relieve symptoms of eye infection, remember never to touch the end of the bottle to your eye. You could contaminate the bottle, which could spread infection.

Different types of eye drops may be required for the various types of eye infection or conjunctivitis:

• Bacterial conjunctivitis usually makes your eyes really red and sore, with a thick, yellow, sticky discharge. Quick Tip: Bacterial conjunctivitis should be treated with Rx antibiotic eye drops, so you must see your eye doctor to get a prescription.
• Viral conjunctivitis can be mild or severe, depending on the virus causing it, and it's also contagious. Some viral types of pink eyes go away on their own. But the severe kind will cause red, watery, sore eyes, along with a clear or whitish discharge. You may also have blurred vision. Quick Tip: If you have viral conjunctivitis, OTC lubricating eye drops can help make your eyes feel better, as can cold compresses or ice packs. But if symptoms grow worse, you should see your eye doctor for treatment.
• 
  Allergic conjunctivitis is the most common cause of eye redness and usually causes itching, swollen lids and watery, bloodshot eyes. Allergic pink eye is not contagious. It can be seasonal (usually spring and fall) or year-round. Quick Tip: You can very often make your eyes feel better with OTC lubricating and antihistamine eye drops and cold compresses or ice packs. Taking OTC antihistamines such as Zyrtec or Claritin can help. You can also try Benadryl by mouth for allergy symptoms, but it can make you drowsy. If symptoms are severe, your eye doctor may need to prescribe stronger eye drops or oral medications.

I enjoy helping my patients figure out what is causing their eye problems and guiding them in their use of over-the-counter versus prescription eye drops or ointments.

Using the appropriate OTC treatments can be easier, cheaper and quicker than a visit to the eye doctor. But I like patients to know when it's appropriate to get me involved, rather than insisting on being their own doctor. If you're going to gamble, don't do it with your eyes!

Please note: If you have an urgent question about your eye health, contact your eye care practitioner immediately. This page is designed to provide general information about vision, vision care and vision correction. It is not intended to provide medical advice. If you suspect that you have a vision problem or a condition that requires attention, consult with an eye care professional for advice on the treatment of your own specific condition and for your own particular needs. For more information, read our Terms of Use.

[Page updated March 2009]