Eye Lubrication

If you cannot close your eye fully then it’s important to administer eye drops to improve lubrication and prevent corneal damage. The normal blinking mechanism of the eye acts to spread the ‘tear film’ across the outer layer of the cornea. This helps keep the eyes lubricated and provide clear vision. When the blink does not work, it is like a faulty window wiper on a car which doesn’t clean the screen effectively and makes it more difficult to see.

What are tears and where do they come from?

Tears are fluid consisting of water, oil, mucus and salt. There are two different types of glands in the eyes:

Lacrimal

There are two lacrimal glands, one above each eye.

The lacrimal tear glands produce the eyes’ watery/mucus tear film that sits on the surface of the eye and helps the tear film stick to the surface of the cornea and keep them hydrated.

Meibomian (“my-BOH-mee-an”)

There are 25 to 40 meibomian glands in your upper eyelid and 20 to 30 in your lower eyelid.

The meibomian glands produce the outer oily layer that prevents the tears from evaporating too quickly and makes the surface of the eyes smooth.

It’s important to understand the different types of glands because some people may have Meibomian gland dysfunction (MGD), this is a blockage or abnormality of the meibomian glands meaning they don’t secrete enough oil into the tears. This can then cause the tear film on the surface to evaporate too quickly. This may be improved by daily hot compresses using a wheat bag for eyes. Please always follow instructions carefully to avoid burning the delicate eye area.

Initial treatment for corneal exposure

Generally the recommended treatment is frequent instillation of artificial tear drops in the day time (at least every two hours) and lubricant ointment at night. If drops are needed more than four times a day they should be preservative-free. Eye drops containing preservatives used over a prolonged period of time or in large quantities may damage the surface of the eye or cause inflammation. It is always important to follow the advice of your ophthalmic care provider or an optician.

You can also use ointment in the day but this causes a blurring of vision and would affect being able to do certain activities such as safely driving a car.

Your ophthalmologist or optician should recommend what drops to use. Sometimes drops are prescribed by your GP or an emergency care provider.

Which eye drops?

NICE guidelines are evidence-based recommendations for health and care in England. The only guidelines specific to facial palsy are for the management of Bell’s palsy. They state that it is important to keep the eye lubricated but there are no further recommendations regarding what kind of drops to use. This can lead to confusion and patients often end up buying over-the-counter drops which can vary greatly and not always provide the relief needed. Hypromellose is one of the most common over-the-counter eye drops used for tear deficiency in patients with mild dry eye and will sometimes contain preservatives depending on the brand you choose. We therefore recommend you discuss with a pharmacist which products are suitable for moderate-severe dry eye when the eyelid does not close properly.

Types of eye drops

Eye ointments

Eye ointments are ideal for bedtime use as they act as a barrier against moisture loss and are long-acting. They are greasy and will blur your vision. You would normally apply a thin line about half an inch in the affected eye(s) before sleep but read the instructions for full details. You should not use ointments with contact lenses. If your eye becomes sorer or extremely red after using an ointment speak to your health care provider because occasionally people are allergic to lanolin alcohols or other ingredients in the ointment.

Lacri-lube® eye ointment used to be a popular choice for protecting the eye but there is currently a global shortage due to manufacturing issues. The Royal College of Ophthalmologists recommend Xailin Night eye ointment and HYLO NIGHT (formerly VitA-POS) as suitable alternatives.

A lanoline-free alternative is HydraMed Night Sensitive.

Eye drops

Eye drops vary by ingredients and if one type of eye drop is not working for you then you may wish to look at others with a different composition.

Sodium Hyaluronate

There are a variety of brands that include this ingredient such as:

• HYLO
• Hyabak® 0.15%
• Clinitas Soothe®
• Systane® Hydration PF
• Evolve® HA

Carmellose Sodium

Brands that include this ingredient include:

• Celluvisc®
• Evolve® Carmellose
• Optive Advanced®

Polyvinyl alcohol

The following are examples of brands containing this ingredient:

• Liquifilm® artificial tears
• HypoTears®
• Sno*tears.

Lipid Polymers

Systane eye drops contain advanced lipid nano-droplet technology with HP-Guar and mineral oil. Remember to consider whether you need preservative-free eye drops.

Disaccharide

Trehalose is a disaccharide. Ophthalmic products containing trehalose first started to be used in the early 2000s. Drops containing trehalose are manufactured by Thea Pharmaceuticals, e.g. Thealoz® Duo (preservative-free). These also contain Sodium Hyaluronate but in a much smaller percentage.

Carboxy methyl cellulose

Commonly known as Hypromellose, brand names such as Evolve® include a Hypromellose option for the relief of dry eye. There are many other brand names of this type of eye lubricant as it is commonly used for milder dry eye symptoms. When comparing brands it is always important to look at the ingredients. Another product containing Hypromellose that is preservative-free is Xailin Hydrate.

Eye gels

Gels may affect vision more than drops but the effects are not as long-lasting as with eye ointment.

Aqueous carbomer gels

• Artelac® Nighttime Gel manufactured by Bausch + Lomb is a carbomer gel.
• Clinitas Hydrate® is another carbomer-based product manufactured by Altacor.
• Xailin Gel is another example and preservative-free.

Disaccharide

Thealoz® Duo Gel contains trehalose as well as sodium hyaluronate and carbomer. This is a thick preservative-free gel.

Links to manufacturers/distributors websites

Please note this is not an exhaustive list and examples given of eye drops are not intended as recommendations. We aim to explain the difference between the type of products available and provide links so you can do your own research.

Xailin: Link to website

HYLO: Link to website

Hyabak: Link to website

Clinitas: Link to website

Systane: Link to website

Thealoz Duo & Duo Gel: Link to website

Artelac Night time gel: Link to website

Evolve/Optive: Link to website

Celluvisc, Liquifilm & Optive: Link to website

HydraMed: Link to website

Struggling to get hold of certain medications? Get in touch and we will see if we can find out when they are due back in stock.

Important to remember

• If one eye drop doesn’t suit you, discuss with your health care provider and try switching to one with different ingredients.
• If buying over-the-counter and trying different options, check the ingredients so you don’t buy two different branded products with the same ingredients.
• If you think eye drops are not helping you, discuss with your health care provider because you may be allergic to an ingredient in the product.
• Always use preservative-free eye drops if using more than four times per day.
• Follow the dosage instructions on the pack carefully.
• If you wear contact lenses, make sure your eye drops are suitable for contact lens wearers.
• Using ointment in the day will affect your vision.

Eye Drop Compliance Aids

If you struggle to administer the drops or gels, there are a variety of dispensing aids available to you that you might find useful, including EziDrops, Opticare and Thea. Some of them may even be available on prescription from your GP/ eye hospital.

Some dispensing aids help to squeeze one drop at a time from a nozzle, and others have extended arms which allow more leverage to squeeze one drop from a nozzle.

The Thea Eyot^® Gel Dispenser is designed to make it easier to administer the single use vials. Your local support group leader may have some of these, or contact us to find out how to order one.

For instructional videos on how to use the compliance aids, visit the Moorfield’s Eye Hospital YouTube channel.

Further information about management of Dry Eye

Visit our Dry Eye Advice patient guide for further information about how to care for your eye(s) whilst experiencing facial paralysis.

Link to Dry Eye page