Comparison of Artificial Tear Supplements on the Ocular Surface Health and Tear Film in Patients with Dry Eye

Abstract

Purpose. To compare the effects of four commonly used, non-preserved, ‘over the counter’ artificial tear supplements on the ocular surface health and tear film of patients with moderate-to-severe dry eye. Methods. A prospective, controlled, investigator-masked, parallel, randomised study design was used to compare three months’ treatment with: (1) carboxymethyl cellulose 0.5% (Cellufresh, Allergan) (2) hydroxy propylmethyl cellulose 0.3% with bicarbonate (Bion Tears, Alcon) (3) carbomer 980 gel 0.2% (Viscotears Gel, Ciba Vision) or (4) hydroxy propylmethyl cellulose 0.3% (Polytears Free, Alcon) (Study: AKX/01/02/004). The cornea, conjunctiva and tear film of one eye of each eligible randomised patient were assessed at baseline (after a 14-day washout), then 1, 2, 4, 8 and 12 weeks after treatment. Results Treatment differences were observed in the sample studied (N = 73). Conjunctival fluorescein staining was significantly different (P = 0.0002) between treatments, with Cellufresh significantly better than each of the three comparators. Tear film contamination was significantly different (P = 0.003) between treatments, with Cellufresh significantly better than Bion Tears and Polytears. For tear film debris, there was a trend (P = 0.053) for a difference between treatments, with the Cellufresh group having the least amount of debris. Frequency of supplement instillation was also significantly different (P = 0.047) between treatments, with Cellufresh requiring the least frequent instillation. There were no detrimental effects on visual acuity or the lipid layer of the tear film detected for any supplement. Conclusions. Commonly used, artificial tear supplements can improve the ocular surface health and tear film in patients with moderate-to-severe dry eye. In this study, the most consistent and favourable results were achieved with the use of carboxymethyl cellulose 0.5% (Cellufresh). Support: Allergan Australia Pty Ltd