Which eye drops should I use, and do they help?

An artificial tear adds volume and lubrication. That genuinely helps for an hour or two, and there is nothing wrong with using them. But if your meibomian glands are blocked, the tears you add evaporate as quickly as the ones you make, which is why people find themselves using drops more and more often for less and less relief.

Needing drops several times a day to stay comfortable is a reason to have the glands assessed, not a reason to buy a bigger bottle.

We recommend preservative-free drops to our dry eye patients as a matter of course. Preservatives keep a multi-dose bottle sterile once it is opened, but agents such as benzalkonium chloride (BAK), polyquaternium-1 and chlorobutanol can irritate an ocular surface that is already inflamed — and the more often you use the drops, the more that matters.

Preservative-free vials are designed to sit closer to your natural tears. They can be used as often as you need them, which is exactly what someone with moderate to severe dry eye ends up doing.

Thicker gels and ointments last longer but blur vision briefly, which makes them better suited to bedtime than to the working day. We will recommend a night-time ointment where it is likely to help.

Drops sold to "get the red out" work by constricting blood vessels. They do nothing for dryness, and used regularly they tend to produce rebound redness that is worse than what you started with. They are not a dry eye treatment.

If you are unsure what is in a bottle you already own, bring it to your appointment — it is a quicker conversation in person than a pharmacy aisle allows.

Drops stay useful during a course of treatment, and we do not ask people to stop using them. What changes for most people is how often they reach for them by the end.

Alongside drops, the daily routine matters. We prescribe four things as a set — our CORE 4: a warm compress held for a full ten minutes followed by a gentle lid massage, lid hygiene wipes along the base of the lashes, preservative-free artificial tears, and a re-esterified triglyceride (rTG) form Omega-3.

The details matter more than people expect. A washcloth does not hold heat for ten minutes, so it does not do the job; the compresses we carry use antimicrobial silica beads and can be used cold as well. Omega-3 supplements vary enormously in quality, and the rTG form is the one that is digested and absorbed properly. A month of the CORE 4 is included in the full treatment plan.