ARTIFICIAL TEARS REFERENCE GUIDE

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1 Lubricating Artificial Tear (OTC) Systane Systane Ultra Refresh Tears Refresh Ultra Soothe (formerly MoistureEyes) Manufacturer Alcon Alcon Allergan Allergan Bausch & Lomb HP-Guar Carbomer, Castor Oil Glycerin Propylene Glycol (1.0%), Glycerin (0.3%) Polyquad 0.001% Polyquad 0.001% Purite Purite BAK 0.01% Safe With SCLs X X Size/Cost * 15mL / $ mL / $ mL / $ mL / $ mL / $7.29 PF Option US only Single Use Vials Single Use Vials (Plus) No No Tears Naturale II (US rebranded Genteal Mild) Tears Naturale Forte (US rebranded Genteal Mod) Genteal Tears OPTI-TEARS Tears Plus Dry Eye Manufacturer Alcon Alcon Alcon Canada Alcon Canada Allergan Canada HPMC 0.3% Dextran % HPMC 0.3%, Dextran %, Glycerin 0.2% HPMC 0.3% HPMC 0.3% PVA 1.4% Povidone 0.6% Polyquad 0.001% Polyquad 0.001% GenAqua Sodium perborate chlorobutanol Safe with SCLs X Size/Cost* 15mL/ $14.49, 30mL / $ mL / $ mL / $ ml / $ mL / $14.49 PF Option Yes 0.6 ml x 24 / $14.49 No No No No Theratears Murine Tears Visine Dry Eye Tired Eyes Visine Dry Eye Environmental Relief Similisan Dry Eye Relief Manufacturer Akorn Prestige Brands Johnson & Johnson Johnson & Johnson Similasan Hypotonic Solution CMC 0.25% PVA 0.5% Povidone 0.6% Glycerin 0.2% v/v HPMC 0.2% Glycerin 0.2% v/v HPMC 0.2% Homeopathic Solution Belladonna 6X, Euphrasia 6X, Mercurius Sublimatus 6X sodium perborate BAK, EDTA BAK EDTA, sorbic acid Silver Sulfate Safe with SCLs No No Yes -- Size/Cost* 15mL /$ mL / $ mL / $ mL / $ ml /14.99 PF Options Single Use Vials

2 Artificial Tear (OTC) Systane Ultra PF Systane Bion Tears Refresh Plus Refresh Theratears PF Manufacturer Alcon Alcon Allergan Allergan Akorn Safe with CLs Size/Cost* Lipid-Based Artificial Tear (OTC) Systane Balance HPMC 0.3% Dextran % PVA 1.4% Providone 0.6% CMC 0.25% 28 x 0.4mL / $ x 0.4mL / $ x 0.4mL / $ x 0.6mL / $18.49 Refresh Optive Advanced Refresh Endura (Emulsion) Liposic Soothe Restore Manufacturer Alcon Allergan Allergan Bausch & Lomb Bausch & Lomb Propylene Glycol 0.6%, dimyristoyl phosphatidylglycerol Glycerin 1% Castor Oil, Glycerin, Polysorbate 80, Carbomer % carbomer 980 Medium-chain triglycerides light mineral oil 1% mineral oil 4.5% Polyquad 0.001% Purite Preservative-Free Cetrimide Polyquad, EDTA Safe with CLs No No No No No Size / Cost * 10mL / $ mL / $ x 0.4mL / $ mL / $ mL / $15.49 PF Option No Yes- Single Use Vials -- No No Lipid-Based Artificial Tear (OTC) / Sprays (PRACTICIONER) Systane Complete Refresh Mega-3 Hylo Calmo Eye Spray BioDrop MD Spray Manufacturer Alcon Allergan Candorvision Promed Services/Piloset Propylene Glycol 0.6% HP-guar Glycerin 1% Polysorbate % Dexpanthenol (pro-vitamin B5) vitamin A, vitamin E soy lecithin Sodium hyluronate Glycerol Polyquad 0.001%, EDTA Preservative-Free Preservative-Free Preservative-Free Safe with CLs No No No No Size / Cost * 10mL/ $ x 0.4mL / US only 10mL / $39.90 MSRP 17mL/ $27.95 Notes mineral oil, dimyristoyl phosphatidylglycerol Castor oil, flaxseed oil, trehalose Liposomal Spray Sea buckthorn oil Microemulsion spray

3 Sodium Hyluronate Containing (OTC) Systane Ultra Refresh Optive Hydration Fusion Blink Tears Hydrasense Manufacturer Alcon Allergan Abbott Medical Optics Bayer Bayer Hydrasense Advanced Polyethylene glycol % Sodium hyaluronate Sodium hyaluronate 0.1% Sodium hyaluronate 0.15% 0.15% Sodium Hyluronate Polyquad 0.001%, EDTA Purite Ocupure (Sodium Chlorite) Safe with CLs Size / Cost * 10mL / $ mL / $ mL /$ mL/ $ ml / $ ml / $17.99 PF Option 30 x 0.7mL / $ x 0.4mL / $29.99 Single Use Vials PF Multidose only PF Multidose only Sodium Hyluronate (PRACTITIONER) Hylo Hylo Dual Hylo Fresh Hyabak idrop Pur Manufacturer Candorvision Candorvision Candorvision Labtician- Thea imed Pharma Sodium hyaluronate 0.15% Provitamin B5 sodium hyaluronate 0.1% sodium hyaluronate 0.05% ectoine 2% sodium hyaluronate 0.03% sodium hyaluronate 0.15% sodium hyaluronate 0.18% glycerin One-way Multidose system Safe with CLs Other Features -- Allergy/Dry Eye Relief EyeBright Hypotonic Solution Self-sterilizing silicone tip Size / Cost 10mL / $39.90 (MSRP) 10mL / $44.90 (MSRP) 10mL /$29.90 (MRSP) 10mL / $20.00 (MSRP) 10mL / $22.00 (MSRP) Sodium Hyluronate Containing Gel (PRACTITIONER) idrop Pur Gel BioDrop MD Hylo Gel Manufacturer imed Pharma Piloset (Dist: ProMed) Candorvision sodium hyaluronate 0.3% sodium hyaluronate 0.2% sodium hyaluronate 0.2% glycerin One way valve system Multidose PF bottle Safe with CLs Size / Cost 10mL / $27.00 (MSRP) 10 ml / $ mL / $49.90 (MSRP)

4 Trehalose Containing (PRACTITIONER) Thealoz Thealoz Duo BioDrop MD Plus Manufacturer Labtician-Thea Labtician-Thea Piloset (Dist: ProMed) trehalose 3% trehalose 3% sodium hyaluronate 0.15% trehalose 2% sodium hyaluronate 0.25% One-Way valve system Safe with CLs After wear Size / Cost 10mL / $25.00 MSRP 10mL / coming soon 10 ml / $23.95 Gel (OTC) Systane Gel Refresh Liquigel Blink Gel Tears Refresh Optive Gel Manufacturer Alcon Allergan Abbott Medical Optics Allergan Bayer Hydrasense Gel CMC 1.0% Polyethylene glycol % CMC 1.0% Glycerin 0.9% Sodium hyluronate 0.3% Polyquad 0.001%, EDTA Purite Ocupure Purite Safe with CLs Remove before use Remove before use Remove before use Remove before use Size / Cost 10mL / $ mL / $ mL / $ mL / ml / PF Option No No No No Multidose Bottle Ophthalmic Gels/ Single Vial Gel (OTC) Systane Gel (Genteal Severe Gel) Liposic Gel Tear-Gel Theratears Gel PF Refresh Celluvisc Manufacturer Alcon Bausch & Lomb Bausch & Lomb Akorn Allergan HPMC 0.3%, Carbopol 980 Carbomer 980, Mediumchain triglycerides Carbomer, sorbitol CMC 1.0% CMC 1.0% GenAqua Cetrimide Cetrimide Safe with CLs No No No Remove before use Remove before use Size / Cost 10mL / $ mL / $ mL / $ x 0.4mL / $18.49 Availability Retail Retail Retail Single Use Vials Single Use Vials

5 Ointment (OTC/DOC) Systane Nighttime (Tears Naturale PM) Genteal PM (Hypotears Ointment) Refresh Lacrilube Soothe Nighttime (formerly Duolube) Ocunox Manufacturer Alcon Alcon Allergan Bausch & Lomb Candorvision Mineral Oil 3% White Petrolatum 94% Mineral Oil 15% White Petrolatum 85% Mineral Oil 42.5% White Petrolatum 56.8% Mineral Oil 20% Petrolatum 80% 250 I.U./g retinol White petrolatum, paraffin, liquid paraffin Other Liquid Lanolin 3% -- Lanolin alcohol -- Wool fat Safe with CLs No No No No No Size / Cost 3.5 g / $ g (US only) 3.5 g / $ g / $ g / $14.90 MSRP Chlorobutanol Anti-Allergy Relief (safe with CLs) Hydrasense Allergy (OTC) Hylo Dual (DOC) Manufacturer Bayer Candorvision sodium hyaluronate 0.15%, ectoine 2% sodium hyaluronate 0.05%, ectoine 2% Sterile filter bottle (up to 3 months) (up to 6 months) Other Features Allergy/Dry Eye Relief Allergy/Dry Eye Relief Size / Cost 10mL / $39.90 (MSRP) 10mL / $44.90 (MSRP) Glossary of 1 Viscosity Agents benzalkonium Toxic effects on corneal epithelium an disrupts lipid in Carboxymethylcellulose Has the best mucoadhesion and increases tear retention time chloride (BAK) tear film (CMC) Chlorobutanol Less toxic to cornea, but less effective against hydroxypropylmethylce Good viscosity agent that prolongs tear film wetting time microbes llulose (HPMC) EDTA Chelating agent, often in conjunction with other preservative. Low antimicrobial effect, can cause sodium hyaluronate shear-thinning polymer that has high viscosity under open eye, but thins under the motion of blink to prevent irritation contact dermatitis Hydroxypropyl guar (HP-Guar) Gellable lubricant designed to mimic the mucin layer of tears, to prolong contact time Cetrimide Propylene glycol Water-based polymer that increases contact time PHMB Effective antimicrobial that disrupts cell wall, with minimal cytotoxic effects on cornea Polyvinylalcohol (PVA) Water-soluble viscosity enhancer that increases contact time with cornea Polyquad (Alcon) An effective antimicrobial, with less cytotoxic effects on cornea due to large molecule size Carbopol gel Decreased viscosity with increased shear force; good mucoadhesion and wetting time Vehicles GenAqua -sodium Disappearing oxidative preservative-- converted to Mineral oil Allows the vehicle to melt at body temperature upon contact perborate (Alcon) H2O2 in light, then O2 and H2O in eye Purite (Allergan) Disappearing oxidative preservative-- dissipates into White Petrolatum Provides longer retention time at corneal surface and H2O and NaCl when exposed to light provide a temporary lipid depot Ocupure -sodium chlorite (AMO) Disappearing oxidative preservative-- dissipates into Na and Cl ions, H2O and O2 when exposed to light Lanolin Added to the non-emulsive ointment base to absorb water 1 Bartlett and Djanuus (2008), Clinical Ocular Pharmacology, 5th edition, 91: doi: /j x * Cost is based on median retail price in Ontario. Prices may vary from store to store and by region. Pricing information is for approximate reference only and may change according to the market. Products exclusive to practitioner includes the MSRP. Disclaimer: This guide is intended for your personal use only. As changes happen to products without notice, and as such may contain errors, and shall not be held responsible for the use and application of any information. All trade names and images belong to its owners. Please use this guide at your discretion CAOS Artificial Tears Guide information compiled by A. Yuen

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