Over the counter (OTC) artificial tear drops for dry eye syndrome

Abstract

Background-Over the counter (OTC) artificial tears historically have been the first line of treatment for dry eye syndrome and dry eye-related conditions like contact lens discomfort, yet currently we know little regarding the overall efficacy of individual, commercially available artificial tears. This review provides a much needed meta-analytical look at all randomized and quasi-randomized clinical trials that have analyzed head-to-head comparisons of OTC artificial tears.Objectives-To evaluate the effectiveness and toxicity of OTC artificial tear applications in the treatment of dry eye syndrome compared with another class of OTC artificial tears, no treatment, or placebo. Search methods-We searched CENTRAL (which contains the Cochrane Eyes and VisionTrials Register) (2015, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE and the US Food and Drugs Administration (FDA) website (www.fda.gov). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 December 2015. We searched reference lists of included trials for any additional trials not identified by the electronic searches.Selection criteria-This review includes randomized controlled trials with adult participants who were diagnosed with dry eye, regardless of race and gender. We included trials in which the age of participants was not reported, and clinical trials comparing OTC artificial tears with another class of OTC artificial tears, placebo, or no treatment. This review did not consider head-to-head comparisons of artificial tears with another type of dry-eye therapy.Data collection and analysis-We followed the standard methodological procedures expected by Cochrane. Two authors independently screened the search results, reviewed full-text copies for eligibility, examined risk of bias, and extracted data. We performed meta-analysis for trials that compared similar interventions and reported comparable outcomes with sufficient data. We summarized all other included trial results in the text.Main results-We included 43 randomized controlled trials (3497 participants with dry eye). Due to the heterogeneity of study characteristics among the included trials with respect to types of diagnostic criteria, interventions, comparisons, and measurements taken, our ability to perform meta-analyses was limited. The review found that, in general, there was uncertainty whether different OTC artificial tears provide similar relief of signs and symptoms when compared with each other or placebo. Nevertheless, we found that 0.2% polyacrylic acid-based artificial tears were consistently more effective at treating dry eye symptoms than 1.4% polyvinyl alcohol-based artificial tears in two trials assessing this comparison (175 participants). All other included artificial tears produced contradictory between-group results or found no between-group differences. Our review also found that OTC artificial tears may be generally safe, bu...

EULAR recommendations for the management of Sjögren’s syndrome with topical and systemic therapies

“…This is overwhelmingly fulfilled by topical therapies (see definition in table 2). Various studies and Cochrane SLRs support the daily use of topical therapies for the symptomatic relief of dryness, with a significant improvement in HRQoL without significant side effects 7 27 28. These therapies should be immediately initiated after objective confirmation of glandular dysfunction.…”

“…The first line of therapy for ocular dryness should be volume replacement and lubrication using artificial tears (AT) and ocular gels, whose main ingredients are lubricants with a polymeric base or viscosity agent (methylcellulose, hyaluronate) with the aim of adding volume to the tear lake, increasing the time the AT remain on the ocular surface, and cushioning the ocular surface to reduce friction between lid and globe 37. All SjS studies testing AT (only one in pSjS-2002 patients) found significant improvements for both subjective and objective ocular outcomes, while a recent Cochrane review on the use of AT for dry eye syndrome showed that they are safe and effective 28. We recommend that all SjS patients presenting with ocular dryness and/or abnormal ocular tests should use AT containing methylcellulose or hyaluronate at least twice daily, with the frequency increased to as often as hourly, as indicated by symptoms and/or objective signs.…”

Over the counter (OTC) artificial tear drops for dry eye syndrome

“…We made this change because of the great variation in artificial tears found in the literature search. Our protocol did not include methods to prepare a “Summary of findings” table or assess the overall quality of evidence, as the protocol was published before this requirement was introduced (Pucker 2012). Although not specified in the protocol, we excluded studies in which the follow-up period was less than one week because our review aimed to investigate longer term outcomes.…”

Assessment and management of dry eye disease

“…Last year a Cochrane Systematic Review found that most overthe-counter artificial tear preparations are similarly effective. 17 Some success has been achieved with antioxidants, and viscosity enhancers such as drops containing HPMC or hyaluronic acid are much used. Hypo-osmolar drops have been available for years and there is interest in newer osmoprotectants, including trehalose, a non-reducing sugar whose molecules cluster in aqueous solution.…”