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.

Hypochlorous Acid Eyelid Sprays: What HOCL Does and How to Use It

✔ Stock on hand — ships NZ-wide from Rose Optometry, Hamilton.

By Jagrut Lallu — BOptom (Hons), MSc Specialty Lenses (Hons), FIAOMC. Therapeutic Optometrist & Contact Lens Specialist. Founder, New Zealand Eye Research Centre; Partner, Rose Optometry; WCO Asia-Pacific Myopia Ambassador; International Myopia Institute NZ Ambassador; Clinical Senior Lecturer, Deakin School of Optometry; Honorary Teaching Fellow, University of Auckland.

Hypochlorous acid — HOCL — is one of the most significant additions to the lid hygiene toolkit in recent years. It is a naturally occurring molecule produced by the human immune system, and in stabilised topical form it addresses the microbial and inflammatory drivers of lid-margin disease more directly than traditional eyelid wipes or scrubs. This article explains what HOCL does, who needs it, and how to use it correctly.

What Is Hypochlorous Acid?

Hypochlorous acid is a weak acid produced by white blood cells (neutrophils) during the innate immune response. It is the same molecule your immune system deploys to kill bacteria, fungi, and viruses at sites of infection. Stabilised HOCL sprays capture this antimicrobial property in a topical form that is safe for use directly on closed eyelids, lashes, and lid margins.

HOCL works through several mechanisms:

Antimicrobial: Disrupts bacterial cell membranes and denatures the proteins of gram-positive and gram-negative bacteria, including Staphylococcus aureus, Staphylococcus epidermidis, and Bacillus oleronius — the bacteria most associated with blepharitis and MGD.
Anti-demodex: HOCL spray used directly to the lid margin has activity against Demodex folliculorum and Demodex brevis, the mite species that colonise eyelash follicles and meibomian gland orifices in demodex blepharitis. Traditional lid scrubs with baby shampoo have minimal effect on demodex; HOCL is a practical first-line option for mild-to-moderate infestation.
Anti-biofilm: Bacterial biofilm on the lid margin — a structured community of micro-organisms embedded in a protective matrix — is resistant to surfactant-based cleansers. HOCL disrupts biofilm architecture, making the underlying bacteria accessible and improving the efficacy of concurrent treatments.
Anti-inflammatory: HOCL downregulates inflammatory cytokines at the lid margin without systemic absorption, reducing the chronic low-grade inflammation that perpetuates both anterior and posterior blepharitis.

Who Needs Hypochlorous Acid Eyelid Spray?

HOCL spray is indicated as part of the daily lid hygiene routine for patients with:

Anterior blepharitis — chronic lid-margin inflammation with crusting, scaling, or collarettes (the telltale frills around the base of lashes in demodex infestation).
Posterior blepharitis / MGD — meibomian gland dysfunction in which staphylococcal colonisation or biofilm formation at the gland orifices drives inflammation and gland plugging.
Demodex blepharitis — infestation confirmed or suspected from collarettes, cylindrical dandruff, or itching at the lid margin, particularly in the evening.
Recurrent styes (hordeola) or chalazia — often driven by staph colonisation; HOCL spray reduces the bacterial load that precipitates these.
Contact lens discomfort related to lid-margin disease — reducing the microbial load at the lid margin improves the quality of the tear film that contacts the lens surface.

HOCL spray can also be used preventively by anyone who wears eye makeup regularly, works in a dusty or high-particulate environment, or has a personal or family history of lid disease.

HOCL Products Available at Rose Optometry

OcuSOFT HypoChlor

A 0.02% HOCL spray formulated specifically for ophthalmic use. Preservative-free, pH-neutral (matching the ocular surface at approximately pH 7.4), and safe for use with contact lenses in situ. The fine-mist spray is applied to closed eyelids and the lid margin and does not require rinsing. The gentle, non-irritating formula makes it suitable for daily use and for patients with sensitive ocular surfaces. OcuSOFT HypoChlor is the formulation most frequently recommended at Rose Optometry for anterior blepharitis, demodex blepharitis, and lid-margin maintenance in contact lens wearers.

OcuSOFT SteriLid

An antimicrobial eyelid cleanser combining HOCL with tea tree oil (TTO) derived components. The addition of tea tree extract provides supplementary anti-demodex activity beyond HOCL alone — tea tree oil has the most robust evidence base for killing Demodex mites, and the combination approach is appropriate in confirmed or heavily symptomatic demodex cases. SteriLid is applied as a foam cleanser to the lid margins using the fingertip or a cotton pad. As it contains TTO-derived actives, it is not recommended for use with soft contact lenses in situ — insert lenses after the cleanser has been fully rinsed.

How to Use HOCL Eyelid Spray — Step by Step

Morning routine (spray form, e.g. HypoChlor):

Remove contact lenses if instructed to do so by your optometrist (HypoChlor is safe with lenses in).
Close both eyes.
Hold the bottle 10–15 cm from the face and spray 2–3 times across each closed eyelid and the upper and lower lash lines.
Allow the spray to remain on the lids for 30–60 seconds — this dwell time is important for antimicrobial effect.
Gently blot away excess with a clean tissue if required. Rinsing is not necessary.
Proceed with the rest of your morning routine. Warm compress (if used for MGD) can follow immediately.

Frequency: Once or twice daily. Most patients with active blepharitis begin with twice daily (morning and evening) for the first 4–8 weeks, reducing to once daily for maintenance once the condition is controlled. Your Rose Optometry optometrist will advise the appropriate frequency based on your clinical picture.

For SteriLid foam: Apply a small amount of foam to the fingertip or a damp cotton pad, close the eye, and gently scrub along the lash line with a circular motion for 30–60 seconds. Rinse with water. Do not use with soft contact lenses in situ.

Is HOCL Safe?

Stabilised HOCL sprays at the concentrations used in ophthalmic formulations (0.01–0.05%) have an excellent safety profile. The molecule is endogenous — it is produced naturally by the body — and the topical concentration is well below any cytotoxic threshold for ocular surface cells. No significant adverse effects have been reported in published clinical trials at these concentrations. HOCL spray does not carry the risk of antibiotic resistance that makes topical antibiotic lid preparations a poor long-term choice for blepharitis management.

HOCL as Part of a Complete Lid Hygiene Routine

HOCL spray works best as part of a layered approach to lid hygiene:

Step 1 — Warm compress: Soften and mobilise inspissated meibum in clogged glands. See our warm compress and heat mask guide.
Step 2 — Lid margin expression: Your optometrist performs this in-clinic to clear blocked meibomian glands. Digital expression can be performed at home for mild MGD.
Step 3 — HOCL spray / lid cleanser: Reduce the microbial and biofilm load at the lid margin while the glands are warm and partially cleared.
Step 4 — Lubricating drops: Support the tear film now that the lid margin has been cleared of biofilm and the meibomian gland orifices are more patent.

Browse our full lid hygiene range — all products stocked on hand in Hamilton, with free optometrist advice included with every NZ order.

References

Willcox MD, et al. TFOS DEWS III: Ocular Surface Disease and Dry Eye. American Journal of Ophthalmology. 2025;279:289-386.
Epstein IJ, et al. Hypochlorous Acid: A Review of the Science and Clinical Application in Ophthalmology. Clin Ophthalmol. 2022;16:1361–1369.
Gao YY, et al. In vitro and in vivo killing of ocular Demodex by tea tree oil. Br J Ophthalmol. 2005;89:1468–1473.

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