Safe eye drop shopping: Tips for the canny consumer
Heads up: This article is not for dry eye nerds (you know who you are) or even for classic dry eye patients… except to the extent it may help you educate the real targets of this article: all the people buying eyedrops without their doctor’s help. So in fact, this article really is written for all of you.
Over-the-counter drops… and dry eye prevention?
Sounds counter-intuitive. If it’s sold over-the-counter, then by definition, it’s safe, right?
Yes - except for all the ones that can be harmful if you continue using them or overuse them. Which is exactly what people do with over-the-counter drops, because they assume, not unreasonably, that if they are sold over the counter, they are safe. But if you think the FDA keeps eyedrops off the shelves that will hurt you if you keep using them, your first step in self-education is to disabuse yourself of that notion.
Here’s one simple but telling fact about the labeling that the FDA requires on eye drops: There’s a little warning required on all of them. It says, “Stop use and ask a doctor if… blah blah blah… symptoms worsen or persist for more than 72 hours.” The wording varies slightly from product to product - but only slightly.
This 72-hour warning is included in the Drug Facts label of every over the counter drop sold in the US. It is on the boxes of perfectly innocuous preservative free drops that most chronic dry eye patients use many times every day for years (or decades), and it is on the bottles of the worst of the worst redness reliever containing two decongestant ingredients with a known rebound redness effect, an astrigent, a potentially drying antihistamine, and the most toxic preservative known to eyedrops.
Even if people read the Drug Facts part of the label, how can they possibly be expected to take a warning seriously that is used indiscriminately - without regard for the purpose or contents of the product? That’s just one example of the useless inanity of the FDA warning labels on over-the-counter eyedrops. The industry has long since outgrown its decades-old regulatory framework.
Ideally, doctors would help make up for this, by guiding their patients’ choices. But the fact is, an awful lot of the people buying over-the-counter eye drops for their irritated, bloodshot eyes aren’t seeing an eye doctor, and have nothing to guide them but the advertising and the outer packaging. So here we are, and here’s your next step in understanding the context:
Don’t underestimate the confusion factor.
Never have drugstore shelves been more confusing.
Having 3,246 different ways to order coffee is one thing. That’s a service. We choose it. But with over-the-counter eye drops, not so much. Ten years or so ago, “There’s a Visine for that” ushered in an entirely new era of confusion and hazards for people just trying to buy eyedrops. And there’s no going back, because of….
The Tribble Effect
Here’s how it happens.
You start with a successful brand, Visine. It’s a get-the-red-out drop and it’s been around approximately forever. It’s harmful when overused (toxic preservative plus rebound redness effect), but nobody knows those things and it’s simple and it’s a household name, so it sells. Then one day, people start getting dry eye symptoms like never before, and then another day, thanks to Janine Turner, they’re actually starting to get educated about it and more choosy with their eyedrops, and then one day, all of a sudden there’s a zillion dry eye drops eroding your customer base. Must…win…back…market…share.
So you cross your branded drop with a tribble.
Now you have ten Visines. Six of them contain redness relievers (you know, those things that fix it temporarily and make it come back worse the next time) but don’t say so in the name. Seven of them contain BAK, the toxic preservative, and, well, ok, that’s par for the course with Visine but on the other hand, one of the seven is specifically advertised for dry eye and people with dry eye are particularly vulnerable to BAK. Meantime, another one of the Visines has Itchy Eyes in the name, and itchy eyes are a classic allergy symptom, but that drop does not contain an antihistamine, unlike the one with Allergy in the name, which by the way has BAK too, but then, there’s a ton of overlap between dry eye and allergy symptoms anyway and are you dizzy yet?
But wait, it gets worse.
Because now there’s ClearEyes. Not just one, but, yes, ten ClearEyes (who counted to ten first, I’d like to know, in the red eye war between brands?) Six of them say “Dryness, burning, irritation” on the label, and of those six, five contain both BAK, the toxic preservative which, incidentally, will eventually cause "dryness, burning, and irritation" if you use it too long, plus one or more rebound-redness-promoting redness reliever ingredients. Now for the love of shareholder value, can anyone explain to me how an eyedrop laced with all that stuff can truly provide anyone with “Complete 7 Symptom Relief” because, yes, that’s the name of one of them?
On the other hand, how I can thoroughly relish excoriating the ClearEyes brand for these shameless sins when they are the only brand to bring out a preservative free redness reliever (Clear Eyes Pure Relief Multi Symptom), which, if you read my last blog post, you now know is not just less sexy but also considerably less sinful than Bausch & Lomb’s new hottie Lumify, depending how much you overuse it?
You get the picture. It’s a miry mess out there. And an awful lot of the people navigating these drops are those who aren’t seeing an eye doctor, so they have not yet had the “preservative-free” dogma drilled into them.
Those of you with dry eye, you are much more likely to walk into the drugstore with tunnel vision. Your eyes are trained on boxes of preservative free vials, which automatically eliminates Visine and ClearEyes and a few BAK-preserved stragglers from B&L and others. You have the expertise, and you can help.
So here's a simple tool:
This is not a list of doomsday eyedrops that have to be avoided at all costs. (I mean, personally I won’t touch any of them with a barge pole, and I think that’s true of a lot of chronic dry eye patients. But then there's the rest of the world, and we have to be realistic.)
The point of this list is that you should avoid chronic daily use, because of the risks. (Of course, avoiding them altogether is a great option for those who are amenable to the idea.)
Using a drop with BAK now and then isn’t tragic, nor is using redness relievers for special occasions and special needs. But getting lulled into thinking these are OK to use every time your eyes need a little something is a problem... because before you know it, the interval between “every time” has shrunk from weeks to days to hours. And it’s a problem that the instructions don’t help with. Lumify says specifically to use it every 6-8 hours. Then it says to stop and ask a doctor if symptoms persist more than 72 hours. But… the fact is, we are human. We read selectively. We take on board the "every 6-8 hours" (especially after we see how fast and well it works!), and conveniently ignore the "stop after 72 hours" part.
So use the Red Alert List as an easy way to identify things that you should either use less of, or none at all. Because remember, prevention is all about less of this, and more of that. These are emphatically on the “Less” list!
Be safe. In an increasingly drying world, protect your eyes. Of all the things that should not harm your eyes, I think we can agree that eye drops should not harm your eyes!
Patients, what can you do to make a difference?
1. Share the Red Alert List with your family & friends.
2. Print out the Red Alert List and take copies to your eye doctor. Encourage them to share it with the drug reps when they visit.
3. Add your comments to this page to encourage the industry to start producing preservative-free alternatives.