Artificial tears: which ones should you choose?

Artificial tears are not chosen by brand, but on four criteria: whether or not they contain a preservative, the packaging, the viscosity, and the mechanism of the dryness. The products seen in pharmacies, Thealose, Vismed, Celluvisc, Hylovis, Artelac, Cationorm, belong to these categories: it is the categories that are compared, not the names. The most useful rule fits on one line: as soon as you instil them often, for a long time, under contact lenses or after surgery, you choose a preservative-free formula.

KEY POINTS

PRESERVATIVES

With or without preservative: the first question to ask

A bottle that is opened and closed for weeks has to stay sterile: “Tear substitutes in bottles generally require a preservative, unlike disposable single-use containers”, summarises the Assurance Maladie ameli.fr. The most widespread is benzalkonium chloride, abbreviated BAK on package leaflets. It is a detergent: it disrupts the membranes of microbes and, in the long run, those of the cells on the surface of the eye. A review published in Eye in 2022 notes that it is found in around 70% of ophthalmic formulations, that it is toxic to the conjunctiva and the cornea, and that its effects, most marked with chronic exposure, can appear after only seven days of use Goldstein 2022.

Hence the paradox highlighted by a review published in Acta Ophthalmologica in 2025: a product intended to soothe the surface of the eye can damage it if it contains a preservative. Of 88 artificial tears on the Nordic market, 32% contained a preservative; by contrast, no evidence of toxicity was found for the active ingredients themselves Mikha 2025.

In practice: for an occasional drop in a healthy eye, the preservative poses few problems. For use several times a day, over a long period, or on an already fragile surface, you choose preservative-free. This applies to people on long-term treatment for glaucoma, whose daily eye drops already expose the surface of the eye, and to patients who have had surgery.

PACKAGING

Single-dose unit, sterile multidose bottle, or conventional bottle?

Many patients believe that “preservative-free” means “single-dose”. That is no longer true: there are three types of packaging, and two of them do without a preservative.

• The single-dose unit: a small vial that you open, use, then discard. No preservative is needed, and it is the form the Assurance Maladie recommends first. Its drawback lies in the volume, far greater than one drop; an opened vial does not keep.
• The sterile multidose bottle: an ordinary bottle fitted with a one-way valve tip. Air and microbes do not travel back into the reservoir, which makes it possible to do without a preservative while keeping a bottle for several weeks. The Assurance Maladie mentions these “one-way valves, allowing multidose bottles to contain no preservatives”.
• The conventional bottle: the cheapest, and the only one that almost always contains a preservative. It remains acceptable for short, infrequent use.

Whatever the format, two rules apply: respect the use-by period after opening, which varies greatly from one system to another, and never touch the eye, the eyelid or the eyelashes with the tip.

TEXTURE

Fluid drop, gel or ointment: a question of viscosity

The Assurance Maladie sums up the trade-off: “The more viscous the product, the greater its capacity to retain water”, but “this texture is responsible for a blurring effect that disappears within a few minutes”. Staying power versus sharpness: that is the whole question.

• The fluid drop (aqueous solutions, low-concentration hyaluronic acid, trehalose, carmellose): comfortable during the day, compatible with screen work and driving, to be renewed more often.
• The gel: thicker, it lasts several hours and blurs vision a little longer. Many patients keep it for the end of the day.
• The night-time ointment: the longest-lasting, applied at bedtime, for eyes that dry out at night or do not close completely during sleep. It blurs vision markedly and is not applied before driving.

Combining a fluid drop during the day with a gel or ointment in the evening is common. It is an adjustment: it is set according to the timing of the symptoms, not the stated strength of the product.

MECHANISM

Not enough water or evaporating too fast: two different kinds of dryness

This is the criterion patients most often overlook, and the one that explains why a product that relieved a relative does nothing for you. The tear film has an aqueous phase, produced by the lacrimal gland, and an oily surface layer, produced by the meibomian glands in the edge of the eyelids. Dry eye can stem from a defect in either one.

• Not enough water (hyposecretion): the lacrimal gland does not produce enough. This is the profile of dry eye syndromes, of certain autoimmune diseases and of many systemic treatments. Aqueous substitutes are directly useful here.
• Evaporating too fast: the quantity of tears is adequate, but the oily layer is of poor quality, most often because of meibomian gland dysfunction. Adding water brings relief for a few minutes, then the discomfort returns. Here, the oily layer has to be restored first, with warm compresses and eyelid hygiene, a baseline treatment shared with blepharitis and chalazion; artificial tears come as a complement.

The TFOS DEWS II report, the international reference on dry eye, concludes that distinguishing these two mechanisms is decisive in choosing the management strategy, while acknowledging that data are lacking to predict the relative benefit of each option in one profile or the other Jones 2017. The category is therefore chosen on the mechanism, the specific product by trial. The French reimbursement rules make the same division, moreover, by treating separately the solutions intended for “dry eye associated with meibomian gland dysfunction” ameli.fr, LPP.

EFFECTIVENESS

Which artificial tears are the most effective?

This is the most frequently asked question, and the honest answer is that there is no ranking. A Cochrane systematic review gathered 43 randomised controlled trials comparing over-the-counter artificial tears with one another or with a placebo, in 3,497 participants. Its conclusion: uncertainty prevails, and the majority of these products may have similar effectiveness. Only one comparison stood out consistently, in two trials and 175 participants, in favour of a 0.2% polyacrylic acid solution over a 1.4% polyvinyl alcohol solution. The overall level of evidence was judged to be low Pucker 2016.

Two lessons. No brand name deserves to be singled out as superior to the others, and a doctor has no business doing so. And if the active ingredients are largely equivalent, what sets products apart lies elsewhere: the preservative, the viscosity, individual tolerance, and whether you actually use them. In everyday practice, it is customary to try a category for two to four weeks, then to change category rather than brand if nothing improves. This benchmark is a consultation-room convention, not a figure drawn from a trial.

PHARMACY AND REIMBURSEMENT

Without a prescription, and reimbursed? What the Assurance Maladie says

Yes, artificial tears can be bought without a prescription. The Assurance Maladie itself invites patients to “use ‘artificial tears’ or tear substitutes available in pharmacies” and to ask the pharmacist for advice; it specifies that they “are to be used as needed and without limit”, and are applied “as often as necessary, once or twice a day or several times an hour” depending on the discomfort.

Reimbursement follows other rules, and this is where the nuance is useful: without a prescription, no reimbursement, even for a product that is otherwise reimbursable. Two statuses coexist in pharmacies.

• Some tear substitutes are medicines holding a marketing authorisation. Celluvisc, a single-dose unit of carmellose sodium, is one example: its official entry states “Conditions for prescription and supply: None”, so no prescription is required to buy it, and a reimbursement rate of 65% when it is prescribed public medicines database.
• Others are medical devices entered on the list of reimbursable products and services. The Assurance Maladie places in this category eye solutions marketed in particular under the names Cationorm, Hylo confort, Hylovis, Optive, Systane ultra, Théalose and Vismed. Their coverage is more tightly regulated: dry eye with keratitis or keratoconjunctivitis sicca, as third-line treatment after failure of low-viscosity substitutes or gels, on prescription by an ophthalmologist, for six months at most, renewable after examination. A prescription from a general practitioner does not open entitlement to coverage ameli.fr, LPP.

In other words: you can relieve the symptoms on your own, but reimbursement goes through a consultation.

CONTACT LENSES

Contact lens wearers: what changes

A contact lens splits the tear film in two and speeds up its evaporation: end-of-day discomfort is its most common expression. Not all drops can be instilled with lenses in place, a compatibility statement is needed on the box, and preservative-free is preferable here, as a preservative can concentrate in the lens material. This discomfort should not be dismissed as routine: the Assurance Maladie lists it among the reasons for a consultation when it “does not stop quickly”, an examination being necessary to look for corneal lesions, and advises preferring glasses during periods of dryness.

AFTER SURGERY

After an operation: why preservative-free is essential

After eye surgery, the ocular surface already receives several eye drops a day for weeks. Adding a preserved tear substitute would mean multiplying the instillations of detergent on a healing cornea: the artificial tears prescribed in this context are therefore preservative-free. For his patients who have undergone cataract surgery, Dr Tourabaly prescribes Hylovis, or Hylocomfort, alongside the anti-inflammatory and antibiotic treatment. The frequency and duration appear on the prescription handed over on the day of the operation: that is what counts, and it alone. The details of the pathway are gathered on the page devoted to recovery after cataract surgery; the grain-of-sand feeling under the eyelid of the first few days is one of the symptoms these drops relieve.

Refractive surgery follows the same logic, for an additional reason: cutting into the cornea transiently interrupts corneal nerves and reduces the secretion reflex. Dryness is expected and transient there, and its management is detailed on the page dry eye after LASIK.

NOT TO BE CONFUSED

What does not replace artificial tears

So-called “anti-redness” or “decongestant” eye drops contain a vasoconstrictor, which narrows the vessels of the conjunctiva. The eye turns white, but nothing has been hydrated: the mechanism of the dryness is untouched, and the redness returns when you stop.

These products are not harmless. The official entry for Collyre bleu Laiter, which combines a vasoconstrictor, naphazoline nitrate, with a dye, indicates a status of List II, prescription only, and a non-reimbursable medicine. Its contraindications include the risk of angle-closure glaucoma and children under three; its adverse effects include an attack of acute glaucoma and, with repeated instillations, troublesome dilation of the pupil and damage to the corneal epithelium. The summary of product characteristics also recommends avoiding contact with soft contact lenses public medicines database.

Two other false good ideas circulate. Saline solution is not an artificial tear: it rinses, it does not lubricate, and instilled over and over it dilutes what little tear film remains. And old eye drops are not to be reused: the use-by period after opening has passed, and an antibiotic or a corticosteroid picked up at random can mask an infection or worsen corneal herpes.

WHEN TO SEEK ADVICE

When dryness should be examined rather than self-treated

Artificial tears treat a symptom. They do not say why the eye is dry, and some causes are treated differently: a systemic disease, an eyelid abnormality, a side effect of a medicine, inflammatory damage to the cornea. The Assurance Maladie identifies four situations that warrant a consultation.

The consultation is not limited to approving a product: it looks for the cause, examines the cornea, the conjunctiva, the eyelids and the meibomian glands with the slit lamp, and is the condition for reimbursement of the solutions entered on the list of reimbursable products and services. It takes place at the Cachan practice as well as at the Cabinet ophtalmologique Sorbonne Saint-Michel, in the 5^th arrondissement of Paris.

FREQUENTLY ASKED QUESTIONS

Frequently asked questions

SOURCES

Scientific sources

1. Pucker AD, Ng SM, Nichols JJ. Over the counter (OTC) artificial tear drops for dry eye syndrome. Cochrane Database of Systematic Reviews. 2016;2(2):CD009729. PMID: 26905373
2. Mikha KN, Rasmussen CEØ, Ahrensberg SNG, et al. Can the choice of artificial tears harm patients? A narrative review with an overview of the Nordic market. Acta Ophthalmologica. 2025;103(5):586-608. PMID: 39921541
3. Goldstein MH, Silva FQ, Blender N, Tran T, Vantipalli S. Ocular benzalkonium chloride exposure: problems and solutions. Eye (London). 2022;36(2):361-368. PMID: 34262161
4. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. The Ocular Surface. 2017;15(3):575-628. PMID: 28736343
5. Assurance Maladie (ameli.fr). Consultation et traitement de la sécheresse oculaire. Updated 23 April 2025. ameli.fr
6. Assurance Maladie (ameli.fr). Que faire quand on a les yeux secs ? Updated 1^st October 2024. ameli.fr
7. Assurance Maladie (ameli.fr). Conditions de prise en charge prévues par la LPP pour les solutions stériles oculaires. ameli.fr
8. Base de données publique des médicaments, the French public medicines database (ANSM, HAS, Assurance Maladie). CELLUVISC 4 mg/0,4 ml, collyre en récipient unidose. medicaments.gouv.fr
9. Base de données publique des médicaments, the French public medicines database (ANSM, HAS, Assurance Maladie). COLLYRE BLEU LAITER, flacon. Updated 31 August 2026. medicaments.gouv.fr

FURTHER READING

Further reading

• Tobradex and Chibro-Cadron: the antibiotic and corticosteroid eye drops after surgery
• Indocollyre: the non-steroidal anti-inflammatory after the operation
• Sterdex: ophthalmic ointment, indications and precautions

Cachan practice · Tel. +33 1 45 47 08 11

INFORMATION

Medical disclaimer

This article is intended for general information and is no substitute for a medical consultation. The product names that appear in it illustrate categories: none is recommended in preference to another.

The regulatory statuses, compositions and reimbursement conditions cited here come from official pages consulted in September 2026; they change, and the pharmacist and your local Assurance Maladie office remain the up-to-date sources. If you have been given a prescription, particularly after an operation, it is the prescription that sets the product, the frequency and the duration, and it takes precedence over any general information.