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.

Preservative-Free Eye Drops: Why They Matter and Who Needs Them

✔ 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. Partner, Rose Optometry.

Walk into any pharmacy and you will find a row of eye drops, most of them in multidose bottles. What the label may not tell you is that those bottles contain preservatives — and that for anyone using drops regularly, those preservatives can do more harm than the dryness they are meant to treat. This article explains what preservatives do to the eye, who should avoid them, and how to identify genuinely preservative-free options.

What Are Preservatives in Eye Drops and Why Are They There?

Preservatives are added to multidose eye drop bottles to prevent bacterial contamination once the bottle is opened. The most common is benzalkonium chloride (BAC) — a quaternary ammonium compound effective against a broad range of micro-organisms. It has been used in eye drops for decades and is still present in the majority of multidose drops sold in pharmacies and supermarkets.

Other preservatives include polyquaternium-1 (Polyquad), sodium perborate, and oxychloro complex (Purite). Some of these are marketed as "gentler" and do break down on contact with the eye, but the safest option for high-frequency use remains a system with no preservative at all.

What Does BAC Do to the Eye?

The TFOS DEWS III Management and Therapy report (2025) — the most comprehensive review of dry eye management in existence — is unambiguous: benzalkonium chloride produces toxic and pro-inflammatory effects on the ocular surface with chronic use. Specifically:

BAC disrupts the tear film lipid layer, worsening evaporative dry eye.
It is directly toxic to goblet cells — the cells that secrete the mucin component of the tear film — reducing their density with repeated exposure.
It induces apoptosis (programmed cell death) in corneal and conjunctival epithelial cells.
It provokes inflammatory cytokine release, perpetuating the inflammatory cycle of dry eye disease.
It sensitises the ocular surface, making contact lens wear and subsequent dry eye treatment less effective.

In practical terms: a patient with dry eye who reaches for a BAC-preserved drop four or more times a day is adding an inflammatory insult to an already inflamed surface. The drop provides temporary relief; the preservative makes the underlying condition worse.

Who Needs Preservative-Free Eye Drops?

The DEWS III guidance and the clinical consensus at Rose Optometry is that preservative-free drops are indicated whenever:

You are using drops more than four times a day — the threshold at which preservative load begins to accumulate.
You have moderate or severe dry eye — the ocular surface is already compromised and less able to tolerate chemical insult.
You have diagnosed blepharitis, MGD or lid-margin disease — the lipid layer is already impaired, and BAC worsens it.
You wear contact lenses — BAC adsorbs into soft lens material and is then released slowly, prolonging ocular exposure far beyond the drop itself.
You are using drops long-term — for a chronic condition, not an occasional need.
You have glaucoma and are already using preserved glaucoma drops — adding another preserved drop compoundsMT the total BAC load on the ocular surface.
You have had ocular surface surgery (cataract, LASIK, PRK) — the surface is healing and preservative exposure delays recovery.

In short: if dry eye is your daily reality rather than an occasional inconvenience, preservative-free is not a premium option — it is the standard of care.

What to Look for in a Preservative-Free Drop

Truly preservative-free drops come in one of two delivery formats:

Unit-dose vials (minims): Single-use plastic ampoules, each containing one to two doses. Opened and discarded; no preservative needed. Examples: Systane Hydration UD, Viscotears Gel PF, TheraTears.

Multidose preservative-free systems: These use a one-way valve or micro-filter that prevents air (and therefore micro-organisms) from entering the bottle. The best-known is the COMOD valve system used in the Hylo range — each bottle delivers over 300 preservative-free doses. Examples: Hylo-Forte, Hylo-Fresh, Hylo-Dual.

The Hylo COMOD bottles last up to six months after opening and represent excellent value for daily users, with no waste from partially-used vials.

Which Preservative-Free Drop Is Right for You?

The active ingredient matters as much as the delivery system. At Rose Optometry, our preservative-free range covers every dry eye subtype:

Aqueous-deficient dry eye (not enough tear volume): Hylo-Forte (0.2% HA, moderate–severe) or Hylo-Fresh (0.1% HA, mild). Avizor Lacrifresh for contact lens wearers.
Evaporative dry eye / MGD (lipid layer failure): NovaTears (perfluorohexyloctane, water-free) or Systane Complete PF (covers both aqueous and evaporative in one drop).
Mixed dry eye: Systane Complete PF, OCuSOFT Retaine CMC, or Hylo-Dual (adds ectoine for the inflammatory component).
Severe dry eye or overnight use: Viscotears Gel PF (carbomer gel, unit dose) or Vita-POS (vitamin A ointment, overnight).
Allergy + dry eye: Hylo-Dual or Cromo-Fresh (sodium cromoglycate, mast-cell stabiliser).

Browse our full preservative-free eye drops range — all stocked on hand in Hamilton, shipping NZ-wide. Not sure which to choose? Contact Rose Optometry; free optometrist advice is included with every order.

References

Jones L, Craig JP, Markoulli M, et al. TFOS DEWS III: Management and Therapy. American Journal of Ophthalmology. 2025;279:289-386.
Baudouin C, et al. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29(4):312-334.

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