A Guide to Ingredients
in Over-the-Counter Eye Drops

Choose the Best Eye Drops for Your Needs

Choosing an over-the-counter eye drop can be daunting. With the myriad of choices in many pharmacies and supermarkets, sifting through all of the different advertisements, product labels, and ingredients can also be challenging.

As I mentioned in my previous post, Drugstore Confusion – Which Eye Drop is Best for Me?, the safest drops for most eye irritation, including dry eyes, is lubricating drops. These are frequently referred to as moisturizing drops or artificial tears.

When determining which product to use, keep in mind that many ingredients can go into a bottle of eye drops. The most common active ingredients include polyethylene glycol, polyvinyl alcohol, propylene glycol, carboxymethylcellulose, povidone, glycerine, and mineral oil.

This list of eye drops is designed to help you make informed choices about the safest and best ingredients for you. Compare ingredients on this list before you shop for eye drops rather than deciphering information on every bottle at the store. You can also take this list to your ophthalmologist and discuss which eye drops are best for you.

Ingredients in Lubricating Eye Drops

The most common eye drops I recommend, especially for Colorado’s dry air, are lubricating. These work by introducing tear elements that add moisture to your eye, similar to how moisturizing lotion keeps your hands and skin from drying out and becoming irritated. Here is a list of ingredients for lubricating eye drops:

Systane Ultra

• Active ingredients:  Polyethylene Glycol 400 0.4%, Propylene Glycol 0.3%
• Inactive ingredients:  Aminomethyl propanol, boric acid, hydroxypropyl guar, POLYQUAD® (polyquaternium-1) 0.001% preservative, potassium chloride, purified water, sodium chloride, sorbitol. May contain hydrochloric acid and/or sodium hydroxide to adjust pH.

Systane

• Active Ingredients:  Polyethylene Glycol 400 0.4%, Propylene Glycol 0.3%
• Inactive Ingredients:  Boric acid, calcium chloride, hydroxypropyl guar, magnesium chloride, polyquaternium-1 as a preservative, potassium chloride, purified water, sodium chloride, zinc chloride. May contain hydrochloric acid and/or sodium hydroxide to adjust pH.

Systane Balance

• Active Ingredients:  Propylene Glycol 0.6%
• Inactive Ingredients:  Boric acid, dimyristoyl phosphatidylglycerol, edetate disodium, hydroxypropyl guar, mineral oil, polyoxyl 40 stearate, POLYQUAD® (polyquaternium-1) 0.001% preservative, sorbitol, and purified water. May contain hydrochloric acid and/or sodium hydroxide to adjust pH.

The only difference between Systane Ultra and Systane is the aminomethyl propanol, which is a clear, colorless liquid that neutralizes acids to form salts and water. Systane Balance is specifically formulated for those who suffer from blepharitis, ocular rosacea, or meibomian gland dysfunction.

Blink Tears

• Active Ingredients:  Polyethylene Glycol 400 0.25%
• Inactive Ingredients:  Boric acid, calcium chloride, magnesium chloride, potassium chloride, purified water, sodium borate, sodium chloride, sodium chlorite (OcuPure^® Brand) as a preservative; Sodium Hyaluronate.

Same active ingredient as Systane.

Refresh Optive Advanced

• Active Ingredients:  Carboxymethylcellulose Sodium (0.5%), Glycerin (1%), Polysorbate 80 (0.5%)
• Inactive Ingredients:  Boric acid; castor oil; erythritol; levocarnitine; carbomer copolymer type A; purified water; and PURITE^®(stabilized oxychloro complex). It may also contain sodium hydroxide to adjust pH.

Refresh Optive

• Active Ingredients:  Carboxymethylcellulose sodium 0.5%, Glycerin 0.9%
• Inactive Ingredients:  Boric acid; calcium chloride dihydrate; erythritol; levocarnitine; magnesium chloride hexahydrate; potassium chloride; purified water; PURITE^® (stabilized oxychloro complex); sodium borate decahydrate; and sodium citrate dihydrate.

Refresh Tears

• Active Ingredients:  Carboxymethylcellulose sodium 0.5%
• Inactive Ingredients: Boric acid; calcium chloride; magnesium chloride; potassium chloride; purified water; PURITE^®(stabilized oxychloro complex); sodium borate; and sodium chloride. It may also contain hydrochloric acid and/or sodium hydroxide to adjust pH.

Refresh Optive adds glycerin to the carboxymethylcellulose in Refresh, and Refresh Optive Advanced adds Polysorbate 80.

Soothe XP

• Active Ingredients: Light mineral oil (1.0%), Mineral oil (4.5%)
• Inactive Ingredients: Boric acid, edetate disodium, octoxynol-40, polyquarternium-1 (preservative), polysorbate 80, purified water, sodium borate decahydrate. May contain hydrochloric acid and/or sodium hydroxide (to adjust pH).

Soothe XP is a different type of eye drop that uses mineral oil instead of the other lubricating ingredients. It is emulsified, so it is white in color when it comes out of the bottle and may blur the vision for a few minutes.

Retaine

• Active Ingredients:  Carboxymethylcellulose sodium 0.5%
• Inactive Ingredients:  Calcium chloride, magnesium chloride, potassium chloride, purified water, sodium chloride, sodium lactate. It may also contain hydrochloric acid and/or sodium hydroxide to adjust pH.

Retaine is similar to Refresh Tears.

 Retaine MGD

• Active Ingredients:  Light mineral oil (0.5%) Mineral oil (0.5%)
• Inactive Ingredients:  Cetalkonium chloride, glycerol, poloxamer 188, tris hydrochloride, tromethamine, tyloxapol, water for injection.

Retaine MGD is also specific for blepharitis, ocular rosacea, or meibomian gland dysfunction and has mineral oil in lesser concentrations than Soothe XP.

Ingredients in “Gets-the-Red-Out” Eye Drops

I do not recommend consistently using Visine, Clear Eyes, or Naphcon-A. Tetrahydrozoline and naphazoline constrict the eye’s superficial blood vessels. Although they make your eyes look less red in the short term, they can also worsen dry eye symptoms in the long run. Your eyes can also develop a tolerance to the whitening effect of these drops, and even greater redness (called rebound hyperemia) can occur when the effect of the drops wears off, making your eyes dependent on these eye drops.

Although I advise that the safest drops for most eye irritation are lubricating drops, this list of ingredients for “gets the red out” products.

Clear Eyes

• Active Ingredients:  Naphazoline hydrochloride 0.012%, Glycerin 0.25%
• Inactive Ingredients:  Benzalkonium chloride, boric acid, edetate disodium, purified water, sodium borate

Visine

• Active Ingredients:  Tetrahydrozoline HCl 0.05%
• Inactive Ingredients:  Benzalkonium chloride, boric acid, edetate disodium, purified water, sodium borate, sodium chloride

Naphcon-A

• Active Ingredients:  Naphazoline hydrochloride 0.025%, Pheniramine maleate 0.3%
• Inactive Ingredients:  Benzalkonium chloride, boric acid, edetate disodium, purified water, sodium borate, sodium chloride, sodium hydroxide, and/or hydrochloric acid

Which Eye Drop is Best for You?

In summary, many lubricating drops are available over-the-counter and have different formulations. No one drop is best for all patients. I recommend trying several types of lubricating drops to determine which ingredients work best for your eyes. When you talk to your ophthalmologist, tell them the name of your eye drop and how often you take it. Contact your ophthalmologist if you experience any side effects after using eye drops.

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About Dr. Ken Kreidl

Dr. Kreidl, originally from San Francisco, started his ophthalmology practice at Boulder Medical Center in 2004. He and his wife, Ryn, a pediatrician, have two children, Luke and Max. Dr. Kreidl loves mountain biking and skiing with his family and was a nationally-ranked tennis player before becoming dedicated to medicine.

Dr. Kreidl offers a full range of ophthalmology services and treatments, including:

• Surgery – Crystalens and Trulign Accommodative Lenses
• Glaucoma – SLT, ALT, LPI
• Diabetes – Retinal Laser Surgery
• Dry Eyes
• Eyelid Surgery
• Eye Trauma
• Complete Eye Exams
• Contact Lenses
• Glasses

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