PurposeTo assess dry eye treatment with four preservative-free dry eye artificial tear treatments to facilitate evidence-based prescribing. Methods ResultsThe impact of each dry eye treatment on ocular signs and symptoms was similar, however OSDI (p=0.002), LIPCOF (p=0.014) and conjunctival staining (p<0.001) significantly improved from baseline. Clinitas Soothe and Hyabak were preferred by 34%/30% of participants, but only subjective comparison with the other drops influenced this choice. TheraTears was preferred (by 24%) by those with a lower baseline tear volume (p=0.01) and Tears Again (by 12%) by those with a thinner baseline lipid layer (p=0.04). The treatment that afforded the greatest improvement in clinical signs did not consistently match each individual's preferred treatment. ConclusionsIf prescribed to a general dry eye population, the artificial tears performed similarly, improving symptoms and conjunctival signs. However, osmolarity balanced artificial tears were the preferred treatment in individuals with low baseline tear volume and lipisomal spray for individuals with a baseline lipid layer deficiency. Key wordsDry eye; carboxymethylcellulose; liposomal spray; sodium hyaluronate; randomised control trial; artificial tears Highlights• In a general dry eye population, the artificial tears tested performed similarly• Treatment effects still evident after 4 months of treatment• Artificial tears provide more than transient relief to symptoms• Artificial tears aid in breaking the vicious dry eye disease cycle• Osmolarity balanced drops preferred by those with low baseline tear volume• Lipisomal spray preferred treatment by those with baseline lipid layer deficiency