Eye drop analysis
Most mild to moderate dry eye patients can (apparently) be managed successfully with the aforementioned artificial tear products. Mine is clearly more severe, so this is only part of the package.
A website with a list of artificial tears. See also Wikipedia
(click for larger image). Source: http://superficieocular.com.ar/material/Referencia%209.pdf
Eye drops I have tried (patient analysis)
1. Systane Ultra Lubricant Eye Drops (Alcon) $9.89 (Priceline) (normal, non-Ultra for $8 – My Chemist Elizabeth St) 
4 our of 5 VERY GOOD
The pH-driven polymerization mechanism of action of Systane is the secret to its effectiveness. It is apparently the first tear to try to address the visual function implications of dry eye. Active Ingredients: Polyethylene Glycol 400 0.4% (Lubricant) and Propylene Glycol 0.3% (Lubricant)
Conclusion: Immediate relief experienced – but not a solution to the problem, of course. The Ultra seems to work better. All the additional stuff it has is sorbitol.
2. Tearsagain (biorevive) $24 (My Chemist Elizabeth st.) 4 out of 5 VERY GOOD
[Cheaper here]
Contains: Soy Lecithin 1.0% (10mg), Sodium Chloride 0.8% (8mg), Ethanol 0.8%, Phenoxyethanol 0.5%, Vitamin A palmitate 0.025%. Vitamin E (tocopherol) 0.002%, Purified water.
Conclusion: Sprayed over the eye, it seems to provide relief when the eyes are burning. I'm happy with it at the moment
3. Revital eyes: (MURINE) $8 or so 3 out of 5 GOOD
Active. Polyvinyl alcohol 5 mg/mL, povidone 6 mg/mL.
Inactive. Potassium chloride, sodium chloride, sodium bicarbonate, sodium citrate, glucose, sodium phosphate (monobasic and dibasic), disodium edetate, benzalkonium chloride, purified water. May contain hydrochloric acid or sodium hydroxide.
Conclusion: GOOD. More soothing than Optive and Refresh liquigel. I'm concerned about benzalkonium chloride so I use this intermittantly – applying other drops where possible, and using this only once or so per day.
4. Optrex (Reckitt Benckiser) $9.70 (My Chemist Elizabeth st.) 3 our of 5 GOOD
Hamamelis water, boric acid, glycerin, borax. Preservative: benzalkonium chloride!!
Conclusion: GOOD. Seems to have something that makes eyes feel more natural at least for a while. The effect does not last, though.
5. Viscotears $6.95 (Bulleen Pharmacy, Bulleen plaza) 3 out of 5 GOOD
This is a tube, a kind of a gel in lieu of artificial tear drops. When used it blurs the eyes considerably. Contains Carbomer (2mg/g), excipients (e.g. Sorbitol).
Preservative: Cetriimide 0.1 mg/g
Conclusion: Not bad: something to use before going out on a walk, for instance.
6. Tears Naturale (Alcon) $9 (My Chemist Elizabeth st.) 
2 out of 5 FAIR. DO NOT PURCHASE AGAIN.
Contains: DUASORB (hypromellose 3mg/ml and dextran 70 1 mg/ml Preservative: POLYQUAD (Polyguaternium – 1) 0.01 mg/ml)
Conclusion: Fair.Not particularly special.
7. REFRESH LIQUIGEL (Allergan) $8 I think 2 out of 5 FAIR. DO NOT PURCHASE AGAIN.
Contains carboxymethylcellulose sodium 10 mg/mL. Preservative: PURITE™ (stabilized oxychloro complex): 0,0075% m/v (oxidative preservative)
Conclusion: A little better than Optive but not good enough.
8. Blink Tears (Abbott Medical Optics) $5.99 (Priceline) 2 out of 5 FAIR. DO NOT PURCHASE AGAIN.
Polyethylene Glycol 400 (PEG 400), OcuPure Preservative (Sodium Chlorite), Sodium Hyaluronate, Boric Acid, Sodium Borate (decahydrate), Sodium Chloride, Potassium Chloride, Calcium Chloride (dehydrate), Magnesium Chloride, Purified Water
Conclusion: No effect. This is a bit odd since Polyethylene Glycol is common with Systane Ultra. But then again, Systane "ordinary" doesn't have the same effect. Clearly the right combination is needed. Since Systane works better, no point buying this.
1 out of 5 POOR. DO NOT PURCHASE AGAIN. Contains Carboxymethylcellulose Sodium 0.5% (5mg/mL), compatible sloutes (Glycerin 0.9%, Erythritol , Levocarnitine) which protect against cell damage by hyperosmolar tears, Purite preserved..
Conclusion: Tried it (including stronger version called Refresh Liquigel). Not at all useful in my case.
10. Poly Visc.$9.95 (Bulleen Pharmacy, Bulleen plaza) OINTMENT 1 out of 5 POOR.
This is to be used at night. Contains paraffin and wool fat.
Conclusion: I found it was not particularly helpful. I don't use it any longer. Instead, I use castor oil.
Yet to try these
* GenTeal eye drops (Novartis, originally marketed by CIBA Vision). The preservative in the formulation, sodium perborate, is an oxidative preservative that is converted to hydrogen peroxide upon contact with water.
GenTeal GEL $8.70 My Chemist Elizabeth St.
SEEMED TO BE OK THE FIRST DAY I TRIED IT.
* Refresh ENDURA (MUST TRY)
* Thera tears (reserach) (website)
* Soothe XP (Bausch + Lomb)
* FreshKote (Focus Laboratories)
Hint from a doctor: "it is my opinion that lacrimal gland dysfunction is not a very common cause of dry eye. the more common cause IMO is eyelid gland dysfunction (meibomianitis, blepharitis, etc).
the solution for some of those with eyelid dysfunction is emollient eyedrops (vs "atrifical" tears). the 2 OTC emollients are "soothe" and "refresh endura". maybe you should try one of those…
CASTOR OIL
ANTI-INFLAMMATORY EYE-DROPS
I've been prescribed FLAREX eyedrops on 17 February and have used them as follows:
a) 26 February to 4 March (7 days – with last dose missed on 4 March since I forgot it at work)
b) 7, 8 March (twice daily each)
I found it first seemed to aggravate symptoms but, coupled with heat therapy, provided significant relief.
I'm now exploring NON-STEROIDAL anti-inflammatory eyedrops
- Ketorolac (Acular®) is indicated for the treatment of allergic conjunctivitis and works in a similar way as aspirin and ibuprofen. Those with aspirin sensitivity or intolerance should not use this medication.
- Diclofenac (http://www.drugs.com/mtm/voltaren-ophthalmic.html)
- ACULAR: http://www.allergan.com.au/userfiles/file/ACULAR_Aus_PI_May08HL.pdf
http://www.ncbi.nlm.nih.gov/pubmed/9745809
Prescription only (not prescribed in Australia)
As dry eye patients approach category 2 severity, additional treatments, including topical steroids, Restasis (cyclosporine, Allergan) or nutritional therapy (fish oil or flax seed oil), might be required. Restasis is a valuable therapy for reducing inflammation caused by dry eye. However, not all patients respond well to Restasis, and many individuals often complain about stinging upon instillation and the cost of the medication, as well as the lag time between the regimen's start and its onset of effect.
Dry eyes are now seen as having an inflammatory component, not just a loss of moisture. To combat the inflammation, some ophthalmologists prescribe drops that contain a very small amount of cyclosporine if the over-the-counter products don't work.
The 2002 FDA-approval of Allergan’s Restasis (cyclosporine A) made it the first prescription eye drop for decreased tear production. "Findings reported in the Archives of Ophthalmology in 2008 showed that about 70% of the dry-eye patients in the study who hadn't had good results with artificial tears responded well to cyclosporine drops." They cost about $250 a month. Moreover, people may have to use them indefinitely, although doctors at the Cleveland Clinic have reported that in a handful of cases, cyclosporine drops seemed to cure dry eyes, so people could stop using them.
Not all patients respond well to Restasis, and many individuals often complain about stinging upon instillation and the cost of the medication, as well as the lag time (6-8 weeks) between the regimen's start and its onset of effect.
Restasis research.| More research | More research | Side effects | More research | Old research | More research
TOPICAL STEROIDS
Additionally, the use of topical steroids, such as Pred Forte (prednisolone acetate, Allergan), Lotemax (loteprednol etabonate, Bausch + Lomb) or Durezol (difluprednate, Alcon), is very important in the management of severe dry eyepatients. But, because of the significant side effects associated with long-term topical steroid use, including increased intraocular pressure, you must monitor these patients and control their doses very carefully.
