Ask the eye doctor: Should I use eye drops?

Dr. Derek Dake of Black Bear Eye Care is accepting reader questions about eyes and eye care. If you have a question for Dr. Dake, email it to blackbeareyecare@gmail.com.

Q. Who should use eye drops, and what kind of drops do you recommend? If I need eye drops more than once or twice a day, should I see my eye doctor?

A. Over-the-counter eye drops can and should be used by many people for many different reasons.

A good rule of thumb when it comes to eye drops is to not use any eye drop that contains tetrahydrozoline or naphazoline. They can mask problems with eyes and actually make problems worse, especially with long-term use. Both of those ingredients cause rebound redness after the medication wears off, and it can also cut off blood flow to the conjunctiva to the eye.

The most common eye drops on the market are artificial tears which are used for dry eye disease. There is not a one-size-fits-all approach to dry eye disease, even with over-the-counter drops. The safest recommendation is to use a preservative-free eye drop containing a lipid supplementation.

Most ocular pharmaceutical companies have their own version of these drops, like Refresh Optive Mega-3, Systane Complete PF or Systane Pro PF, Retaine MGD, Soothe Preservative-Free. Because these drops do not contain a preservative, they are also safe to use with contact lenses.

The normal dose for drops is four times per day. You can use preservative-free drops more often than four times a day, but drops with preservatives can irritate your eyes and should not be used more than four times a day. If you feel you need eye drops more than four times per day, you should probably consult your eye care provider to see if there are better options for your dry eye symptoms.

Other useful drops help fight allergies, which can certainly make eyes itchy. These drops should include an antihistamine and a mast cell stabilizer. The ingredients in these are olopatadine for the gold standard or ketotifen for their budget-friendly cousin. Allergy eye drops can be used up to two times per day, although some of the ketotifen drops are once per day.

A third type is used to treat corneal edema from underlying corneal dystrophies. These drops have their place in eye care, but are not usually needed without a suggestion from your eyecare professional. The main ingredient in this eye drop or eye ointment is a concentrated sodium chloride solution.

A fourth type of eye drops are vasoconstrictors used for treating eye redness. My advice is to be careful with that type of eye drops, because they usually don’t treat the underlying problems—which are usually dry eye or allergies.

Again, you do not want to take any drops with naphazoline or tetrahydrozoline due to compound redness and restriction of all blood flow. Brimonidine is a newer version of the vasoconstrictor, and it does not cause those side effects.