Eye health resource
Preserved vs. Preservative-Free Eye Drops for Dry Eye
Preservatives help keep multidose eye drops safe, but they can irritate some dry eyes—especially with frequent use. Learn when preservative-free tears may help.
Reviewed for accuracy by Justin Bazan, OD on .
Eye drops with preservatives are not automatically “bad.” Preservatives help keep multidose bottles from becoming contaminated after they are opened. The problem is that some preservatives can also irritate the ocular surface, especially when drops are used frequently or when the eye is already sensitive or significantly dry.
For occasional use, a preserved artificial tear may work well for many people. When artificial tears are needed frequently, or when a person has moderate or severe dry eye, preservative-free options are often worth considering.
What Is Dry Eye?
Dry eye occurs when the eyes do not make enough tears, the tears evaporate too quickly, or the tear film does not function well enough to keep the eye's surface comfortable and stable.
Symptoms can include:
- burning or stinging
- a scratchy or gritty feeling
- redness
- watery eyes
- light sensitivity
- intermittent blurry vision
Because dry eye has many possible causes, the best treatment is not always the same from one patient to another.
Why Do Some Eye Drops Contain Preservatives?
A multidose bottle is opened and handled repeatedly. Preservatives help limit microbial growth so the contents remain safer to use over time. That is an important benefit.
The tradeoff is that the same ingredients can be irritating to some eyes. Benzalkonium chloride, often abbreviated BAK, is one well-known ophthalmic preservative that can affect the ocular surface with repeated exposure. Other preservative systems may be better tolerated, so it is not accurate to treat every preserved product as identical.
When Are Preservative-Free Artificial Tears Worth Considering?
Preservative-free tears may be a good choice when:
- you need lubricating drops many times during the day
- a preserved drop stings or seems to make symptoms worse
- your dry eye is moderate or severe
- your eye doctor recommends minimizing preservative exposure because of your ocular-surface condition
Preservative-free products are available in single-use vials and, increasingly, in specially designed multidose bottles. Packaging varies, so follow the product's storage and discard instructions.
Does “Preservative-Free” Mean the Drop Is Better for Everyone?
No. The most important question is whether a particular drop is appropriate for your eyes and how often you need it. Artificial tears differ in viscosity, lipid content, active lubricants, and other ingredients. Someone with primarily evaporative dry eye may benefit from a different formulation than someone whose eyes do not produce enough tears.
It is also possible to have symptoms that feel like dry eye but come from another problem, including allergy, eyelid inflammation, contact-lens issues, or corneal disease. If symptoms persist, an examination is more useful than repeatedly changing over-the-counter drops on your own.
Can You Use Artificial Tears as Often as You Want?
Follow the directions for the specific product you are using. When lubricating drops are needed very frequently, many eye-care professionals prefer preservative-free formulations to reduce repeated preservative exposure.
If you find yourself reaching for drops throughout the day, that is also a reason to ask why your eyes are dry rather than treating frequency alone as the solution.
Dry-Eye Treatment Is More Than Choosing a Bottle
At Park Slope Eye, current dry-eye care may include appropriate over-the-counter artificial tears, lid-hygiene cleansers, prescription eye drops, and punctal plugs when indicated. The treatment plan depends on the cause and severity of the symptoms.
We do not present every dry-eye patient as needing an in-office procedure. The goal is to identify what is contributing to the problem and choose a treatment that fits the individual eye.
When Should You Have Dry Eyes Evaluated?
Schedule an evaluation if dryness is persistent, repeatedly interferes with contact-lens wear or daily activities, or does not respond to reasonable over-the-counter care. Significant pain, substantial light sensitivity, discharge, or a sudden change in vision should not simply be assumed to be dry eye.
Find a Drop That Fits Your Eyes
Preservatives serve a useful purpose, but more preservative exposure is not always better for a sensitive ocular surface. If you are unsure whether to use preserved or preservative-free tears—or if your current drops are not giving enough relief—Park Slope Eye can help determine what is driving your symptoms.
Book an appointment to discuss persistent dry-eye symptoms.
Originally published . Substantially updated .