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.

The Rose Optometry Dry Eye Drop Formulary: Chemical Composition and DEWS III-Based Use

✔ Stock on hand — every product in this formulary 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.

Tear supplements remain the cornerstone of dry eye disease (DED) management. The TFOS DEWS III Management and Therapy report (2025) positions them as first-line therapy, working to replenish, conserve and stabilise the tear film. But the modern shelf is crowded, and two drops that look identical on a pharmacy shelf can be built on entirely different chemistry and intended for entirely different disease. This formulary sets out every dry eye drop, gel and ointment stocked at Rose Optometry, Hamilton, and maps each one — by its active chemistry — to the DEWS III framework a clinician actually prescribes within.

Matching the Drop to the Disease: The DEWS III Framework

DED is not one condition. TFOS DEWS classifies it into aqueous-deficient dry eye (too little tear volume), evaporative dry eye (usually meibomian gland dysfunction, where the lipid layer fails and tears evaporate too fast), and the mixed disease most patients actually have. Underlying all subtypes is a core mechanism of tear hyperosmolarity and surface inflammation — the self-perpetuating vicious circle of DED.

Tear-supplement chemistry maps onto this. Viscosity-enhancing demulcents (hyaluronic acid, carmellose/CMC, hydroxypropyl guar, PEG, hypromellose, dextran) primarily address aqueous deficiency. Lipid-containing formulations (mineral oil, phospholipid emulsions, perfluorohexyloctane) address evaporative disease by restoring the lipid layer. Osmoprotectants (trehalose, ectoine) counter hyperosmolarity at the cellular level. DEWS III is explicit that preservative load matters: preservatives such as benzalkonium chloride are toxic to the ocular surface with chronic use.

The Rose Optometry Drop Formulary

Product	Core Chemistry	DEWS III Target	Preservative	Clinical Role
Hylo-Forte	Sodium hyaluronate 0.2%	Aqueous-deficient / mixed	PF (COMOD)	Moderate–severe lubrication, long residence
Hylo-Fresh	Sodium hyaluronate 0.1%	Aqueous-deficient	PF (COMOD)	Mild dryness, screen fatigue
Hylo-Dual	Sodium hyaluronate + ectoine	Mixed + allergic/inflammatory	PF (COMOD)	Dryness with allergic or inflammatory surface
Avizor Lacrifresh	Sodium hyaluronate 0.15%	Aqueous-deficient	PF	Contact-lens-compatible lubrication
Systane Hydration UD	HA + HP-guar + PEG (unit dose)	Aqueous-deficient / mixed	PF	Dual-polymer lubrication, post-surgical
Systane Ultra	PEG-400 + propylene glycol + HP-guar	Aqueous-deficient	PF single dose / preserved multidose	Fast-acting environmental relief
Systane Complete PF	Propylene glycol + HP-guar + nano mineral-oil	Mixed (aqueous + evaporative)	PF	All-subtype all-in-one drop
Polytears	Dextran 70 + hypromellose 0.3%	Aqueous-deficient	Preserved	Economical everyday tear
TheraTears Drops	Carmellose 0.25%, hypotonic, electrolyte-balanced	Aqueous-deficient + hyperosmolar	PF / perborate	Counters tear hyperosmolarity
OCuSOFT Retaine CMC	Carmellose + cationic oil-in-water nano-emulsion	Mixed / MGD	PF	Restores aqueous and lipid together
Systane Balance	Propylene glycol + mineral oil + phospholipid (LipiTech)	Evaporative / MGD	Preserved (Polyquad)	Restores lipid layer in MGD
NovaTears	Perfluorohexyloctane (F6H8) 100%, water-free	Evaporative / MGD	PF	Ultrathin anti-evaporative film
Rohto Dry Aid	HP-guar + TPGS vitamin-E derivative	Evaporative / mixed	Preserved	Non-blurring evaporative relief
Systane Gel Drops	PEG-400 + HP-guar (high viscosity)	Aqueous-deficient / severe	Preserved	Long-lasting / bridging to night
TheraTears Gel	Carmellose 1%, hypotonic electrolyte	Aqueous-deficient / severe	PF unit dose	Moderate–severe, night-time
Viscotears Liquid Gel	Carbomer 980 (polyacrylic acid) 0.2%	Evaporative / aqueous	Preserved	High-retention gel for daytime
Viscotears Gel PF	Carbomer 980 0.2%	Evaporative / aqueous	PF unit dose	Same gel for preservative-sensitive eyes
Poly Visc	White soft paraffin + liquid paraffin + wool fat	Evaporative / exposure	Preserved	Night-time protective ointment
Vita-POS	Retinol palmitate (vitamin A) in paraffin base	Evaporative / exposure	PF	Night ointment for exposure / lagophthalmos
Optimel Manuka Eye Drops	Standardised manuka honey ~16%	Evaporative / MGD + blepharitis	PF	Antibacterial and osmotic lid-margin support
Optimel Manuka Forte Gel	Standardised manuka honey ~98%	MGD / blepharitis	PF	Higher-strength night application
AEON NaCl 5%	Hypertonic sodium chloride 5%	Adjunct — corneal oedema	PF	Osmotic corneal deturgescence (not a comfort drop)
Cromo-Fresh	Sodium cromoglycate 2%	Adjunct — allergic surface	PF	Allergic conjunctivitis overlapping DED

Aqueous Replacement: Hyaluronic Acid

Hyaluronic acid (HA) is the most important single molecule in the modern dry eye formulary. It has strong water-binding and shear-thinning behaviour — viscous when the eye is still, thinning on the blink so it does not blur vision. DEWS III cites a systematic review of 18 studies showing HA-containing supplements outperform non-HA supplements for ocular staining and symptoms. Hylo-Forte and Hylo-Fresh are graded by HA concentration (0.2% and 0.1%), so severity of aqueous deficiency guides the choice. All are preservative-free; Hylo's COMOD multidose valve delivers over 300 preservative-free doses per bottle.

Lipid-Based and Water-Free Formulations

Where the problem is evaporation, replacing water is not enough — the lipid layer must be restored. DEWS III reports lipid-containing supplements outperform non-lipid drops in evaporative and mixed DED. Systane Balance uses a mineral-oil and phospholipid system built specifically for MGD. NovaTears (perfluorohexyloctane) is a water-free, preservative-free semifluorinated alkane that spreads as an ultrathin film to physically slow evaporation — with Phase III randomised trial evidence.

Gels and Night-Time Ointments

Heavier agents are positioned for severe disease and overnight use. Viscotears Gel PF (carbomer, preservative-free unit dose) sits between a drop and an ointment. For the night, Vita-POS (vitamin A in paraffin, preservative-free) and Poly Visc protect the surface through the hours of reduced blinking.

Preservative-Free Options at Rose Optometry

DEWS III is unambiguous: benzalkonium chloride is toxic to the ocular surface with chronic use. The formulary above is weighted heavily toward preservative-free options. Browse our full preservative-free eye drops range or the complete dry eye drops collection.

References

Jones L, Craig JP, Markoulli M, et al. TFOS DEWS III: Management and Therapy. American Journal of Ophthalmology. 2025;279:289-386.
Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification. The Ocular Surface. 2017;15(3):276-283.

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