What are the best eye drops for dry eyes?

There is no single “best” eye drop for dry eye, as treatment depends on the underlying cause. According to the TFOS DEWS III framework, dry eye is a multifactorial disease involving tear film instability, inflammation, and ocular surface damage. For many patients, preservative-free lubricating eye drops are recommended as first-line therapy, particularly for frequent or long-term use. An optometrist can help select drops based on tear quality, evaporation rate, and ocular surface findings.

How often should I use eye drops for dry eyes?

The frequency of eye drop use depends on symptom severity and the type of drop used. Preservative-free drops may be used multiple times per day, whereas preserved drops should be used less frequently to avoid ocular surface irritation. If drops are needed more than 4–6 times daily, clinical guidance generally recommends preservative-free formulations and a dry eye assessment.

Can you use eye drops too often?

Yes. Overuse of preserved eye drops can worsen dry eye symptoms by disrupting the tear film and irritating the ocular surface. DEWS III emphasises minimising preservative exposure and addressing underlying causes—such as meibomian gland dysfunction or inflammation—rather than relying solely on frequent lubrication.

What is the difference between Polytears, Systane, and Hylo eye drops?

Polytears, Systane, and Hylo are lubricating eye drops, but they differ in formulation, viscosity, and preservative status. Some are better suited for mild, intermittent dryness, while others are designed for more persistent symptoms or contact lens wear. Brand name alone does not determine suitability; clinical evaluation does.

Are preservative-free eye drops better for dry eyes?

For many patients, yes. Preservative-free eye drops are commonly recommended for moderate to severe dry eye, frequent use, contact lens wear, and sensitive eyes. DEWS III highlights that long-term preservative exposure can contribute to ocular surface irritation in some people.

Can contact lens wear make dry eye worse?

Contact lenses can exacerbate dry eye symptoms by disrupting tear film stability and increasing evaporation. However, with appropriate lens materials, care systems, and compatible eye drops, many contact lens wearers can remain comfortable. Drops labelled as safe for use with contact lenses are typically preferred during lens wear.

How do I know which eye drops are right for me?

Dry eye is not a single condition. Effective management requires identifying whether symptoms are driven by evaporation, aqueous deficiency, inflammation, or eyelid disease. A dry eye assessment—including tear stability, ocular surface staining, and meibomian gland evaluation—helps guide targeted treatment rather than trial-and-error.

Are thicker eye drops better than watery ones?

Not always. Thicker drops may provide longer relief but can blur vision and may not be ideal for daytime use. Thinner drops may be better tolerated but may require more frequent application. DEWS III supports matching drop viscosity to symptom pattern and lifestyle needs.

Can dry eye be treated without eye drops?

Yes. While lubricating drops are commonly used, DEWS III emphasises a stepwise approach that may include eyelid hygiene, heat therapy, management of meibomian gland dysfunction, environmental modification, and lifestyle changes such as reducing prolonged screen use. Eye drops often remain part of treatment when symptoms affect comfort or visual quality.

When should I see an optometrist for dry eyes?

Seek professional assessment if symptoms are persistent, worsening, or affecting activities such as reading, screen use, or driving. Ongoing reliance on eye drops without improvement suggests an underlying issue that may require targeted treatment.

Diabetic Retinopathy and Diabetes Eye Checks in NZ: What to Look For and How Often to Be Seen

By the Rose Optometry optometrist team, Hamilton. General information only — it does not replace an eye examination. Numbered references are listed at the end.

Diabetic retinopathy is damage to the small blood vessels of the retina, the light-sensitive layer at the back of the eye, caused by diabetes. It remains the leading cause of preventable blindness in working-aged people [1]. Found early, it can usually be managed before it affects sight.

Why you cannot rely on symptoms

People with vision-threatening retinopathy may have no symptoms at all [2]. That is the whole reason for regular diabetes eye checks: to find it while you still see well. New Zealand guidance estimates that 20 to 25% of people with diabetes have some form of retinopathy [3].

The stages

Non-proliferative retinopathy. Retinal vessels become damaged and leak; usually without symptoms [1].
Diabetic macular oedema. Fluid collects at the macula, the part of the retina used for reading and detail. It is now the most common way retinopathy causes vision loss in developed countries [4].
Proliferative retinopathy. Abnormal new vessels grow on the retina and need prompt specialist treatment [1,2].

Who is most at risk?

Longer duration of diabetes [2,3]
Higher long-term glucose [2,3] — see blood sugar and HbA1c levels in NZ
High blood pressure and abnormal blood fats [2]
Kidney disease [2,3]
Pregnancy in someone who already has diabetes [2,3]
A rapid, marked improvement in glucose control over three to four months [3] (see below)

What about smoking? A meta-analysis of 73 studies found smoking was linked to more retinopathy in type 1 diabetes (risk ratio 1.23) but not in type 2, where the findings were inconsistent [5]. Stopping smoking is still strongly advised for your heart, kidneys and blood vessels.

How often should you have a diabetes eye check in NZ?

The national guidance sets a standard screening interval of two years, which can be extended to three years if no retinopathy was found at the last screen and HbA1c has consistently been 64 mmol/mol or below [3]. Screening starts:

Type 2 diabetes: at the time of diagnosis [3]. A 2026 Health New Zealand notice adds that people newly meeting the lowered HbA1c threshold may have photoscreening deferred for three years unless there are clinical concerns [6].
Type 1 diabetes: within five years of diagnosis [3].
Pregnancy with established diabetes: in the first trimester. Women with gestational diabetes do not need screening [3].

Publicly funded retinal screening is organised through your GP or local diabetes service [3]. Our optometrists also provide diabetic eye examinations in Hamilton — book at roseoptom.co.nz.

What lowers the risk

Glucose control. In type 1 diabetes, intensive treatment reduced the risk of developing retinopathy by 76% and slowed progression of existing mild retinopathy by 54% over 6.5 years [7]. In type 2 diabetes, tighter glucose control reduced small-vessel complications, mainly the need for retinal laser, by 25% over ten years [8].
Blood pressure control. In people with type 2 diabetes and high blood pressure, tighter control reduced two-step worsening of retinopathy by 34% and loss of three lines of vision by 47% [9].
Keeping your screening appointments, even when your vision feels fine.

If your glucose is about to improve a lot

In the DCCT trial, retinopathy worsened temporarily in 13.1% of people starting intensive treatment versus 7.6% on conventional treatment, with about half recovering by 18 months. Lowering glucose more gradually was not shown to prevent this, and the long-term benefits of good control greatly outweighed it [10]. Current guidance is that retinopathy status should be assessed when glucose-lowering treatment is intensified [2]. Some people use a continuous glucose monitor to follow their day-to-day patterns; we stock the LinX CGM sensor for people who buy their own.

How is it treated?

Sight-threatening disease is treated by an ophthalmologist:

Anti-VEGF injections into the eye are first-line treatment for most diabetic macular oedema that involves the centre of the macula and affects vision [2].
Laser treatment reduces the risk of vision loss in high-risk proliferative retinopathy; in the Diabetic Retinopathy Study it cut severe vision loss from 15.9% in untreated eyes to 6.4% in treated eyes [2].
Vitrectomy surgery is occasionally needed for advanced disease [1].

Treatment is better at preventing vision loss than at restoring it [1], which is why finding sight-threatening changes before vision is affected matters.

Common questions

Can diabetic retinopathy improve?

Mild retinopathy can stay stable and sometimes improves. Good glucose and blood pressure control are proven to slow it [7,8,9]. Improvement has been shown in a trial of the blood pressure medicine candesartan in type 2 diabetes, where 19% of treated people improved compared with 14% on placebo [11].

Is a diabetes eye check the same as a normal eye test?

Not quite. It centres on a detailed look at, and photographs of, the retina. If drops are used to widen your pupils, your vision may be blurry for a few hours, so bring sunglasses and arrange not to drive.

Does blurry vision mean I have retinopathy?

Not necessarily — a change in glucose can itself shift your focus for weeks. But any change in vision in someone with diabetes should be checked.

When is it urgent?

Sudden loss of vision, a sudden shower of new floaters, flashing lights, or a curtain across your vision should be seen the same day.

References

Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010;376(9735):124-136. doi:10.1016/S0140-6736(09)62124-3
American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1). doi:10.2337/dc26-S012
Ministry of Health. Diabetic Retinal Screening, Grading, Monitoring and Referral Guidance. Wellington: Ministry of Health; March 2016.
Tan GS, Cheung N, Simó R, et al. Diabetic macular oedema. Lancet Diabetes Endocrinol. 2017;5(2):143-155. doi:10.1016/S2213-8587(16)30052-3
Cai X, Chen Y, Yang W, et al. The association of smoking and risk of diabetic retinopathy in patients with type 1 and type 2 diabetes: a meta-analysis. Endocrine. 2018;62(2):299-306. doi:10.1007/s12020-018-1697-y
Health New Zealand. Changes to the HbA1c threshold for diagnosing diabetes and prediabetes in New Zealand. 8 June 2026. healthnz.govt.nz
Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986. doi:10.1056/NEJM199309303291401
UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-853. doi:10.1016/S0140-6736(98)07019-6
UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317(7160):703-713. PMID 9732337
Diabetes Control and Complications Trial Research Group. Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch Ophthalmol. 1998;116(7):874-886. doi:10.1001/archopht.116.7.874
Sjølie AK, Klein R, Porta M, et al. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. Lancet. 2008. doi:10.1016/S0140-6736(08)61411-7

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