Dates: August 4-9, 2026

Participants: 336

Part 1: "My knowledge of preservatives in eye drops is..."

Part 2: Preservatives in OTC lubricant eye drops

How often do participants use drops packaged as follows:

For those who use only preservative-free drops, what are their reasons?

• 49% only use preservative-free because they believe preservatives are toxic and could make their dry eyes worse.
• 38% use only use preservative-free drops because those are their doctor's instructions.
• 30% use only preservative-free drops because they believe they are allergic to preservatives or that they bother their eyes.

Also, 25% of participants say they only purchase drops sold in single-use vials.

What about those who use drops with preservatives?

11% of participants use preserved lubricant eye drops daily, citing convenience, cost, lack of availability of their preferred drop in PF packaging, or other.

Learning point: Not all preservatives are equal.

Only 16.4% said "I believe some preservatives are worse than others". 

And yet, this is actually quite important. The harshest preservative in common use for ophthalmic drugs is benzalkonium chloride ("BAK"). This preservative is no longer used in most reputable brand-name OTC lubricant eye drops. However, it is used in (1) some private label and generic OTC lubricant drops, (2) other classes of OTC eye drops and of course (3) many prescription eye drops (such as corticosteroids and glaucoma drugs) where it is standard.

Preserved lubricant eye drops typically contain a milder preservative such as stabilized oxychloro complex or polyquaternium-1. 

Part 3: Other OTC eye drops

How often do you use non-prescription eye drops for allergy symptom relief (e.g. Pataday, Zaditor) or redness relief (e.g. Visine, Clear Eyes, Lumify)?

I was glad to see most people use these infrequently, since almost all of them contain BAK:

Is your eye doctor involved in your choice of these types of eye drops?

(128 participants)

Hm. Sounds like many people could benefit from sharing more with their eye doctor about the OTC eye drops they are using. Doctors, I hope you're asking your patients about their OTC drops. Better yet, make it a routine practice to ask them to bring all their drops to their appointment.

Part 3: Prescription eye drops

• 56% of participants are currently using 1 or more prescription eye drops.
• 14% do not know whether the prescription drugs they are using are preserved.
• 10% have discussed the preservative risks with their eye doctor. [Good job! I hope everyone else will do this too!]
• 3% are using a drop they know is preserved but they are not sure which preservative it contains. [Consider looking it up! Or ask us!]
• 5% are using a prescription drop preserved with BAK, and 4% are using drops not available in preservative-free form.
• 8% are getting eye drops specially compounded so that they can be presevative-free.

Participant comments + Rebecca's comments

Rx drops - glaucoma

TIP for glaucoma patients - check out our BAK is BAD page, which shows concentrations of BAK in the various meds and which are available either with a milder preservative or preservative-free.

• How can I find out if/what preservatives are in Meibo and XDEMVY? 

• DailyMed is the ingredient bible!

• Miebo is not preserved. It is a single chemical drop (no water, even).

• Xdemvy is preserved with potassium sorbate.

• My concern is that the newest glaucoma drops all contain preservatives. Isn't Big Pharma getting the message?  I have advanced glaucoma, but am on the only preservative-free drops (3) available. When they no longer work, I cannot try the new drops.  I may have to sacrifice vision because BAK destroyed my corneas leading to dry eye and neuropathic pain, which has been debilitating at times. 

• Change is an agonizingly slow process. We have to keep advocating as loudly as possible. BAK is very cheap and very, very effective, so industry will always prefer it till they have compelling reasons not to. Sadly, even with PF options available, they are often not accessible to all patients who need them. 

• I have glaucoma, and use 3 different prescription eyedrops.  

• If you haven’t already, please check them for benzalkonium chloride and discuss options with your doctor. If they all have BAK, that’s pretty rough on the corneas.

• I have been using Timoptic Ocudose since January 2023 and now can't get the Rx filled as there is a shortage.  I called Bauch & Lomb and they said they can't tell me when they might be back, just that it has not been discontinued.  I have severe dry eye and was told never to use eye meds with preservatives.  

• Please see comment on the blog post from Cindy Edwards about generic availability!

• My glaucoma drops contain preservatives but my insurance co. will not approve the preservative free ones.

• Have you taken this all the way through the exceptions processes? Sometimes if you fight hard enough (with some help from your doctor) you can win. 

• "I have severe glaucoma in addition to dry eye. My eye doc has said that preservatives have a deleterious effect on the glaucoma and must be avoided to the extent possible.  Unfortunately two of the glaucoma drops are not available in PF form which makes it all the  more necessary that any other drops I use must be PF.  As an aside, I find the single use vials extremely annoying.  Furthermore, I am convinced that as yet there is no cure for dry eye, only symptom relief which varies widely at best.  As you can no doubt tell, I am venting and I don't know that any  of this is of use to you.  To the good, I am using the neoprene sleep goggles at night, and that seems to be helping for night time relief.

• I am sorry, I know that’s a tough situation and you are in good company, there are many others whose essential glaucoma medication types are not yet available in PF format. For prescription meds, it is very rare for any preservative-free eye meds to be offered in multi-dose preservative-free packaging, unfortunately. I’m glad the goggles are helping! Yes, symptom management is the key task for a lot of dry eye situations but it depends on the causes and contributors.

• I don't want my vision declining as a result of preservatives, namely BAK, in the glaucoma eye drops which are supposed to be preserving my vision.

• BAK shouldn’t worsen the vision in any direct way but it can certainly worsen dryness. If you are using a BAK-preserved glaucoma medication for which there are no better options, then it may be necessary to increase dry eye treatments to compensate. Worth a conversation with your specialist!

• I have progressing glaucoma and have been prescribed Rocklatan. The BAK is .02% and I am having more severe dry eye since starting this medication. I use it in combination with Cosopt. During my last visit to my OD, who inserts punctal plugs every three months, my corneas are "beat up"!

• Sorry to hear it! I wonder if more lubrication (like a strong hyaluronate drop a little while after applying the Rocklatan) or a more aggressive prescribed dry eye treatment might help.

Rx drops - dry eye & other

For reference, among the 8 FDA-approved dry eye drugs, Eyesuvis is the only one containing preservatives (Eyesuvis is a steroid for short term use).

• My doctor hasn't mentioned if Tryptyr is preservative free, but I can't take anything with cyclosporine so I'm not sure what to do.  She does recommend and I agree that I should only be using PF drops

  • Tryptyr is preservative-free and it is not cyclosporine.

• I’m using Vevya and Miebo. Very small bottle for 30 day supply. 

  • No preservatives in either. They are also both waterless eye drops.

• I have no other choice but to use Pred Forte nightly for anti rejection purposes.

  • Yes, sometimes it’s all about the lesser of evils isn’t it!

• Using prescription eye drops in the past caused neurotrophic keratitis of my cornea. I am cautious about using any drops with preservatives. My dry eyes have greatly improved since using preservative free eye drops. 

  • Glad to hear your eyes have improved!

• One of the symptoms of my Long Covid (along with making my dry eye worse) is frequent viral conjunctivitis that rapidly becomes a secondary bacterial infection. At those times I must use Polytrim which contains preservative, which always ends up irritating my eyes. At 2 days in, the bacterial conjunctivitis clears up, three days in the allergic conjunctivitis starts. It’s pretty awful!!

  • I'm so sorry. I wish there were better options!

• I should know whether my Xiidra has preservatives, and if so, which one(s), but I don't.

  • Xiidra is preservative-free. Of the 8 FDA-approved dry eye drugs on the US market, ALL are preservative-free except Eyesuvis, which is a steroid for short term use.

• I have had 4 eye surgeries in the last year.  Multiple eye drops have been prescribed as part of recovery and one low dose permanent because of "the trauma we caused to your eye trying to restore vision".  I wish they did not have preservatives but they are not offered otherwise.  Like many medicines, I feel like I have to weigh the benefits of the medicine with the side effects/consequences of the medicine.  Without the surgeries my vision was totally gone.  I chose to have the surgeries and, therefore, the drops and hope that the consequences are not worse than the condition that required their use.

  • Quite right. Risks are always relative. In many situations, preservatives including BAK are a perfectly acceptable tradeoff. The reason I run these surveys is mostly to raise awareness about preservatives in the OTC drops but also to increase awareness of potential harm from prescription drugs that might have better alternatives - but knowing all the while, sometimes there just are no acceptable alternatives. 

• I had one eye doctor in the past recommend preservative free drops, but most of my eye doctors are not knowledgeable about preservatives, and it is difficult to get them to use a compounding pharmacy (ImprimisRX) so I can get them without preservatives. I recently moved to a new state, and Imprimis does not ship here, so I am wondering how to navigate that. 

  • Oh, that’s rough! Maybe let us know what state and we’ll see if we know anyone with a good option? 
    

Rx drops - blood-based

A lot of people mentioned serum tears, so I made a separate section for it. In case you’re curious, for purposes of surveys like this, blood-based eye drops fall into the prescription drug category. They are not ‘manufactured’ and are not subject to a drug approval process, but they still require a prescription. Since I’m on the topic I want to mention Vital Tears, who offer a convenient national service. Some of us have insurance coverage for Vital Tears.

• I have blood drawn and made into eye drops for me. 

• I don't think the survey captured my situation. I found that all OTC eye drops irritate my eyes. I'm using autologous serum eye drops. I'm grateful they work for me. I have chemical sensitivity, and I'm used to looking closely at labels.

• I recently started autologous serum drops. I occasionally still use preservative-free OTC drops. No preservatives ever except the awful ones at eye appointments even though I tell them I am allergic to preservatives. 

• N/A - I use PRP eye drops [that’s platelet-rich plasma]

• Most eye drops didn't work for me (or made my corneas worse).  I use autologous serum drops made from my own blood.  Thank goodness they help, or I would have needed cornea transplants.

Best practices for using OTC eye drops

• People should know to write the dates on the bottle after opening. Doctors should encourage bottles and ampules to be kept in a clean pouch -- not in a lint-filled pocket or car center-console. They should also encourage hand hygiene before instilling drops.

• Hear, hear! Thank you so much for bringing up these very practical points! These are things that I hardly ever remember to talk about so I appreciate you. Some readers might enjoy these videos too:

• How hot do eye drops get in my car?

• How hot do eye drops get in my pocket?

OTC drops - allergy & redness

• I travel to Europe to get preservative free allergy drops. 

• It’s awful that they do not sell these in the US!

• I use Pataday Extra Strength, which is only available with preservatives. I don't know of any mass market USA allergy eye drops that are preservative-free, and it's too much hassle and expense to get Pataday compounded.

• There aren’t any. There was one briefly - Alaway PF - then it went away again a few years ago. I’m hoping someone will eventually bring out a PF olopatadine. 

• The lack of preservative free alternatives for the more medicinal kinds of eye drops is sad. I have to use Cromolyn Sodium and Pataday daily, and my choices are: consume BAK or get GPC from my contact lenses. I have to use these for the rest of my life, so it's a disappointing tradeoff. 

• Yes. We really need industry to step up with better options!

• I stopped using allergy drops because of BAK and have ordered some from Australia that do not contain BAK. My vision has improved in the week since I stopped using BAK. We need options in the US and I'm tired of waiting.

• Thanks for this education! I sometimes use Lumify but had no idea about the BAK risk. I appreciate your information about Lumify PF and will also be more mindful about use of these drops.

• Allergy eyedrops - I know of only 3 that are preservative-free. Alaway PF (apparently discontinued - "out of stock"), Claritin Eye (hard to find. I get them from Canada), and Optase Allegro. 

• I don’t understand why OTC PF ketotifen gtts aren’t sold in USA. I’ve been buying them from a New Zealand pharmacy, but with tariffs, they currently won’t send to USA. So, had to resort to getting from compounding pharmacy. 

• I wish there was an allergy stop like Pataday that was BAK free. 

OTC drops - lubricants

• Can you buy any preservative free lubricating drops that are not individual doses?  I do not like using the individual doses.  Also, 

  • YES! Please check out the table at this link. (You might need a computer rather than phone to see it clearly.) The column at the far right is all the many preservative-free eye drop brands available in bottles.

• I use a variety of eyedrops: autologous tears, mostly preservative free, however, the drop that seems to help me most is Systane Ultra which is NOT preservative free. My longtime Bascom Palmer eye docs are aware and cautioned me since they are preserved, however the bottle with the tip is much easier to use than the fatter-tipped preservative-free bottles and individual vials which I also use. Should Systane Ultra offer a preservative free drop in the tipped bottle, I would switch to it immediately.

  • Good news: Systane Ultra IS available preservative-free, both in vials and bottles. Here’s a link. The first two products listed are what you’re looking for.

• I find that even preservative free drops often irritate my eyes. 

  • You’ve touched on a very important point. Just because a drop is PF doesn’t mean it’s any good, that is, effective for you. We all have different tolerances with the various lubricant drops. Harmless ingredients can be irritating, viscosity or ‘feel’ of an eye drop can be irritating, etc. Even the ‘buffer’ ingredients which are just added to balance the pH can be extremely irritating for some people.

• Sadly they [preservatives, I assume] irritate my eye. I use Celluvisc every 30-45 minutes and Lacrilube and night with an Eye LOCC adhesive cover. 

• I wish Siccaforte (OTC in Austria and Germany) was FDA approved here bc I trust European standards

  • I agree. FDA does not approve OTC - they either fit in the narrow rules defined in the 1980s, or they don’t. Frustrating situation. We are advocating for modernization of the OTC monograph system for eye drops.

• My eye doctors have always told me to use preservative free eye drops. I had been using eye drops that came in single use vials. At one visit, my eye doctor suggested I try Ivizia in special preservative free bottle.  Some time later  I started exploring other eye drops on The Dry Eye Shop website. I found Rebecca’s description of each eye drop helpful in narrowing down which eye drops (there are so many eye drops!)  to try to see if they might give me greater relief. Right now I’m using an eye drop that is in a special preservative free bottle. I only became aware that there are problems and dangers with OTC eye drops from The Dry Eye Shop website. I’m not well-versed in all of the issues,  but I did get info on special preservative free bottles from The Dry Eye Shop and the Dry Eye Shop  made me aware there are dangerous OTC eye drops out there. 

  • Happy to help :) Thanks for sharing

• I use PF eyedrops primary to lubricate my scleral lens as needed.   Usually once or twice a day.  
  

Other / General comments

• Will you be selling Evo Tears 100% Perfluorohexyloctane

• We would if we could! It is a travesty that this is not available for legal sale on an OTC basis in the US.

• I didn’t feel like your statements covered my situations. You seem to have a gap there.

• Sorry about that - I know we couldn’t get quite everything. That’s one of the reasons I love the comments people share.

• I used preservatives in eye drops for 20 years and then developing an allergic reaction

• That can definitely happen!

• I researched my eye drop options early on (a decade ago) and learned of the problems with (& without) preservatives, so have always opted for PF vials. Doctors don't seem to know much of anything about this, & neither do my dry eye friends & relatives. I try to spread the the word & the need for caution.

• Good work raising awareness!

• Doctor said preservatives are only a concern for people who use drops long term. Occasional users it doesn't matter so much. Long term users it can lead to more dry eye. 

• That’s perfectly reasonable. People with significant dry eye are usually using drops at least daily, and sometimes many times per day, so that’s the situation where PF can be quite important, even if there is no allergy or sensitivity to the preservative.

• I recently discovered that whatever preservative is in preserved saline bottles makes my eyes sting when I use it just as a droplet to wet my plunger to remove my scleral lenses. The bottle doesn’t list ingredients, so I only know that it is preserved, not which one is the culprit.

• Ah yes. Contact lens solutions do not have the same kind of labeling as drops because drops are considered drugs while contact lens solutions are considered medical devices. The package insert should list this information if the box or bottle does not, but it's typically listed as contents, not ingredients, and it’s not always easy to spot. If you let us know which product, we're happy to chase down this information for you.

• Multi-dose preservative-free drop bottles are too difficult to squeeze! Do you know of any that are easier?

• Have you tried the Comod type bottle? There are only a couple drops in the US that use it (Optase Hylo Relief and Optase Hylo Forte - the latter is a really great drop actually). You don’t squeeze it - you pump the bottom. I don’t know if it would be easier for you but it might be worth trying. Also, if you haven’t already tried Ivizia, the larger bottle size is easier for some people to use compared to the Novelia and Aptar bottles. - Even among the standard size ones they are definitely not all the same. Wish you could come into our shop - we have a tray of samples specifically to let people test the squeezability!

• Occasionally an eye doctor puts a drop in my eye without really asking (eg numbing drop.) My primary optometrist knows my preference for PF, so he asks first and discusses the pros and cons. I always appreciate that. I've never asked if the yellow stain is PF, but the one my primary doc uses comes in individually-wrapped strips, so I assume it is, whereas the specialist I went to used stain from a dropper bottle without discussing with me. 

• The strips are PF, not the drops. It’s always OK to have special requests for appointments - just alert the tech to the fact there is a test you either don’t want done or want to be done in a particular way, for example.

• The dry shop informed me of everything I needed to know and my Dr. agreed

• Aw that makes me feel so good!

• I was told to use PF only but I still have some eye drops that have preservatives due to traveling abroad and not being able to always have access to PF or my preferred eye drops.

• Makes sense! There are many reasonable uses of lubricant drops with mild preservatives.

• Never use eye drops that contain preservatives per my Dr’s advice. Been using preservative free drops for 10 years. I had Steven’s Johnson syndrome 10 years ago from Bacterium. Have severe dry eye now and also wear Prose lenses. 
  

• My eye Dr recommends only preservative free and that's what I use and my eyes are worth the money!

• You are my primary source of info about preservatives in eye drops, vials, and mdpf bottles. Thank you!

• I also am so afraid of preservatives based on doctor that the wipes I use to clean my eyes are also preservative free

Advocacy / Things we’d like to change

• BAK should be banned for use in any eye drop whether it is OTC or prescription. Its cytotoxic effects on the ocular surface have been well-known for decades. 

• Can we lobby the companies to stop using BAK? I need the steroids but they only come with preservatives.

• In response to the last 2 comments - I don’t believe they’ll ever stop but they definitely need to be making BAK-free alternatives and ensuring that they’re accessible to those who need them!

• I think the issue regarding preservatives in eye drops needs to be more widely addressed. I know an elderly man with dry eyes who was using an antihistamine drop with BAK several times a day. 

• YES! It really bothers me that BAK preserved drops are freely sold with no warning except the standard warning that is on all eye drops sold OTC. Did you know that even preservative-free eye drops carry the warning “Stop use and ask a doctor if… the condition worsens or persists for more than 72 hours”? The BAK-preserved drops say the same thing. So how could any casual purchaser of drops know that frequent use of a BAK-preserved drop has special risks?

• Why don’t more eye professionals warn against BAK?

• Good question. I think that for OTC drops, it’s not high on anyone’s radar and doctors often aren’t aware what OTC drops their patients are using. (See the survey question where only 10% of participants talked to their eye doctor about their OTC drops for allergy, redness etc.) We encourage eye doctors to ask their patients to always bring all their eye drops to appointments! Also, for sure not all eye doctors are equally aware of the harm of BAK exposure over the long term.

To  the many people who expressed appreciation for this survey, thanks so much for the kind words - I appreciate you!