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Is it safe to use "Redness Relief" eye drops regularly?
The short answer is NO.
Here’s the slightly longer answer.
There are several eye “Redness Relief” products on the over-the-counter market, such as those made by Visine, Clear Eyes, and Bausch & Lomb - as well as generic versions sold by pharmacy chains.
Most commonly, the active ingredient in redness relief drops is either Tetrahydrozoline or Naphazoline. Both of these drugs are in a category called sympathomimetics.
Sympathomimetics, the active ingredient in redness relief drops, work though a process called vasoconstriction, an artificial clamping down of the superficial blood vessels on the eye surface. These blood vessels often dilate in response to an irritation. This increase in blood flow is trying to help repair whatever irritation is affecting the surface of the eye. Clamping down on those vessels by using a vasoconstrictor counteracts the body’s efforts to repair the problem.
The other downside to repetitively using redness relief drops is that after the vasoconstrictor wears off the vessels often dilate to an even larger degree than when the process started. This stimulates you to use the drops again.
All of these drops carry these same two warnings on their labels:
Do not overuse as it may produce increased redness of the eye.
Stop using and ask a doctor if you experience eye pain, changes in vision, continued redness or irritation of the eye, condition worsens or persists for more than 72 hours.
Does anyone read those warnings? Almost never.
These drops are meant to be used for a VERY short duration - one or two days. That’s it!
They are not meant to be used indefinitely and they are certainly not meant to be used daily.
Take a good look at that first warning: MAY PRODUCE INCREASED REDNESS OF THE EYE.
If you are using redness relief drops repetitively you are likely making your eye redness WORSE, not better.
If you have been using redness relief drops daily you need to stop and replace them with an artificial tear or lubricating drop - something that DOES NOT say “gets the red out.”
After you make that switch your eyes are initially going to be red as your blood vessels take time to regain their normal vascular tone without the vasoconstrictor clamping down on them. The lubricating drop will actually help to repair the damage done by exposure to adverse conditions. This will decrease the inflammatory signals that make the vessels dilate. You will actually be doing something helpful to the surface of your eyes instead of just masking everything by artificially clamping down on your vessels and decreasing the flow of oxygen and nutrients to the front surface of your eye.
Using redness relief drops if you wear contacts is an even worse idea. If you put the drop in with your contact in, the contact will hold onto the drug and keep it on your eye surface longer, thus likely increasing the vasoconstriction.
Your cornea has no blood vessels in it and it depends on the blood vessels in the conjunctiva over the whites of the eye to bring in nutrients and oxygen. The other source of oxygen for the cornea is what it gets from diffusion from the atmosphere and that is also cut down by the presence of the contact lens.
The redness relief drop combined with the contact lens are now BOTH reducing the levels of oxygen getting to the cornea. Decreased oxygen to the cornea is one of the biggest risks for contact lens-related infections, including corneal ulcers.
Don’t get me wrong, I’m not condemning redness relief drops if used appropriately for a very short time to soothe the eyes if they have been temporarily exposed to elements that made them irritated. For a day or two redness relief drops are fine. But for long-term use or for use while wearing your contacts they are much more likely to cause problems than to provide any benefits.
Article contributed by Dr. Brian Wnorowski, M.D
This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.
There are several different variations of glaucoma, but in this article we will mainly focus on Primary Open Angle Glaucoma. This means that there is no specific underlying cause for the glaucoma, like inflammation, trauma or a severe cataract. It also means that the drainage angle where fluid is drained from the inside of the eye into the bloodstream is not narrow or closed.
Closed or Narrow Angle Glaucoma, which we won't be discussing today, is treated differently from Open Angle Glaucoma
In the U.S., Primary Open Angle Glaucoma (POAG) is by far the most common type of glaucoma we treat.
Glaucoma is a disease where the optic nerve in the back of the eye deteriorates over time, and that deterioration has a relationship to the Intraocular Pressure (IOP). Most - but not all - people diagnosed with glaucoma have an elevated IOP. Some people have fairly normal IOP’s but show the characteristic deterioration in the optic nerve. Regardless of whether or not the pressure was high initially, our primary treatment is to lower the IOP. We usually are looking to try to get the IOP down by about 25% from the pre-treatment levels.
The two mainstays of initial treatment for POAG in the U.S. are medications and laser treatments. There are other places in the world where glaucoma is initially treated with surgery. However, while surgery can often lower the pressure to a greater degree than either medications or laser treatments, it comes with a higher rate of complications. Most U.S. eye doctors elect to go with the more conservative approach and utilize either medications, most often in the form of eye drops, or a laser treatment.
Drops
There are several different classes of medications used to treat glaucoma.
The most common class used are the Prostaglandin Analogues or PGA’s. Some of the PGA’s available in the U.S. are Xalatan (latanaprost), Travatan (travapost), Lumigan (bimatoprost) and Zioptan (tafluprost).
PGA’s are most doctors’ first line of treatment because they generally lower the IOP better than the other classes, they are reasonably well tolerated by most people, and they are dosed just once a day. Most of the other drugs available have to be used multiple times a day.
The other classes of drugs include beta-blockers that are used once or twice a day; carbonic anhydrase inhibitors (CAI’s ), which come in either a drop or pill form and are used either twice or three times a day; alpha agonists that are used either twice or three times a day; and miotics, which are used three or four times a day. All of these other medications are typically used as either second-line or adjunctive treatment when the PGA’s are not successful in keeping the pressure down as single agents.
There are also several combination drops available in the U.S. that combine two of the second-line agents (Cosopt, Combigan, and Symbrinza).
Laser
The second option for initial treatment is a laser procedure.
Two common laser treatments for Open Angle Glaucoma are Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT). These treatments try to get an area inside the eye called the trabecular meshwork - where fluid is drained from the inside of the eye into the venous system - to drain more efficiently.
These treatments tend to lower the pressure to about the same degree as the PGA’s do with over 80% of patients achieving a significant decrease in their eye pressure that lasts at least a year. Both laser treatments can be repeated if the pressure begins to rise again in the future, but the SLT works slightly better as a repeat procedure compared to the ALT.
Article contributed by Dr. Brian Wnorowski, M.D.
This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.
