Dry Eye Drops

Concise summaries of dry eye drops, lubricants, and anti-inflammatory agents used in optometric practice in Singapore, including practical guidance on pharmacology, dosing, patient selection, and monitoring.

Last updated: March 2026

What are dry eye drops?

Dry eye drops are topical ophthalmic preparations applied to the ocular surface to supplement, stabilise, or replace the deficient tear film in dry eye disease (DED). The TFOS DEWS II definition characterises DED as a multifactorial condition of the ocular surface characterised by a loss of tear film homeostasis, accompanied by ocular symptoms, in which tear film instability, hyperosmolarity, ocular surface inflammation, and neurosensory abnormalities play aetiological roles.^[1]

In Singapore, dry eye disease is highly prevalent and driven by a convergence of environmental and behavioural factors unique to the region: near-universal use of air-conditioning, high digital screen exposure, one of the world's highest contact lens-wearing rates, and a large post-refractive surgery (LASIK) population. Prevalence estimates in Singapore range from 12–35% depending on diagnostic criteria, with evaporative dry eye due to meibomian gland dysfunction (MGD) representing the dominant subtype.^[2,3]

Drug classes

Aqueous lubricants — polymer-based drops (hyaluronic acid, carboxymethylcellulose, hydroxypropyl methylcellulose, polyethylene glycol) that supplement the aqueous tear layer; first-line for most patients; available OTC.
Lipid-containing emulsions — oil-in-water or water-in-oil emulsions that restore the lipid layer and reduce evaporative loss; indicated primarily for evaporative dry eye and MGD; available OTC.
Ocular lubricant ointments — highly viscous petrolatum-based preparations (e.g., Lacrilube) providing prolonged surface protection; primarily for nocturnal use in severe aqueous-deficient dry eye or nocturnal lagophthalmos.
Immunomodulators (cyclosporine) — calcineurin inhibitors that reduce T-cell mediated ocular surface inflammation underlying moderate-severe DED; onset 3–6 months; require ophthalmologist prescription (POM).
Corticosteroids — short-course topical steroids (e.g., fluorometholone, loteprednol) for acute inflammatory exacerbations of DED; POM only; mandatory IOP monitoring.

Who are they for?

Dry eye drops are indicated for patients presenting with dry eye disease across the full severity spectrum. In Singapore, the prevalence of DED is amplified by environmental conditions — the widespread use of air-conditioning creates chronically low indoor humidity (often below 50%), exacerbating tear film instability year-round. Combined with long screen hours, a high-myopia population with large post-LASIK cohorts, and a tropical climate driving heavy contact lens use, Singapore optometrists encounter dry eye as one of the most common presenting complaints in practice.^[2,3]

Patient profiles and common conditions

Evaporative dry eye / MGD

Most prevalent subtype in Singapore; driven by screen use, AC exposure, and meibomian gland dropout. Lipid-layer deficiency leads to rapid tear evaporation.

Aqueous-deficient dry eye

Reduced lacrimal secretion; associated with age, Sjögren's syndrome, systemic medications (antihistamines, antidepressants), and post-radiation.

Contact lens-related dry eye

Lens-induced tear film disruption and reduced blink rate; extremely common in Singapore's large CL-wearing population; preservative-free lubricants preferred.

Post-LASIK / post-surgical dry eye

Corneal nerve transection reduces afferent reflex tearing; may persist 6–12 months; common in Singapore's high LASIK uptake population.

Digital eye strain / screen-related DED

Reduced blink rate during prolonged screen use; worsened by AC environments; prevalent in Singapore's office and student populations.

Sjögren's syndrome-associated DED

Severe aqueous deficiency; requires systemic workup and co-management with rheumatology; cyclosporine or autologous serum often needed.

Caution — contact lens wearers

Many artificial tear formulations contain benzalkonium chloride (BAK) as a preservative, which adsorbs onto soft contact lenses and may cause toxic keratopathy with repeated exposure. In Singapore's high contact lens-wearing population, this is a clinically significant counselling point. Advise all contact lens patients to instil preserved drops at least 15 minutes before lens insertion, or — preferably — to use preservative-free formulations (e.g., unit-dose vials or COMOD-bottle HA drops such as Hylo-Forte or Hycosan) which are safe to use while wearing lenses.

When should they be used?

Symptomatic relief — mild dry eye

Begin with an OTC aqueous lubricant (hyaluronic acid or CMC) used PRN or up to QID for patients with intermittent symptoms and normal or mildly reduced TBUT. In Singapore, preservative-free HA drops (Hylo-Forte, Hycosan) are preferable for frequent daily use given the high ambient AC exposure and contact lens use. Patient education on the blink reflex and screen break habits (20-20-20 rule) should accompany pharmacological management.

Maintenance and prophylactic use — moderate dry eye

For persistent moderate symptoms with reduced TBUT, corneal staining, or MGD findings, step up to regular scheduled dosing (QID) of an aqueous lubricant, with addition of a lipid emulsion (Systane Balance) for the evaporative component. Nocturnal ointment (Lacrilube) may be added for patients with significant overnight symptoms or nocturnal lagophthalmos. Oral omega-3 supplementation is adjunctive and evidence-supported for MGD-predominant DED.

Escalation and referral — severe or inflammatory dry eye

When moderate-to-severe symptoms persist despite optimised lubricant therapy, or when significant corneal staining (Oxford grade ≥2), filamentary keratitis, or mucous plaques are present, refer to an ophthalmologist for consideration of cyclosporine (Restasis or Ikervis), short-course corticosteroid, punctal occlusion, or autologous serum drops. Singapore optometrists do not have prescribing rights for POM agents — referral is mandatory for any patient requiring these treatments.

Severity	Recommended agent	Duration / Action
Mild — intermittent symptoms	HA or CMC lubricant PRN	As needed; lifestyle modification
Mild-moderate — persistent symptoms	HA QID ± lipid emulsion BD	Ongoing; review at 4–6 weeks
Moderate — MGD / evaporative	Lipid emulsion QID + nocte ointment	Ongoing; add warm compresses / lid hygiene
Moderate-severe — inflammatory DED	Cyclosporine 0.05% BD (Restasis) — refer	Minimum 3–6 months; ophthalmologist only
Severe — acute inflammatory exacerbation	Short-course FML or loteprednol — refer	2–4 weeks; specialist co-management
Severe / refractory — Sjögren's / filamentary	Ophthalmology referral ± autologous serum	Specialist management; ongoing monitoring

Where are they available in Singapore?

In Singapore, dry eye drops span all three regulatory categories under the Health Sciences Authority (HSA) Medicines Act (Cap. 176). Most aqueous lubricants and lipid emulsions are classified as General Sale medicines (OTC), making them accessible without prescription. Immunomodulators (cyclosporine) and corticosteroids are Prescription-Only Medicines (POM) that may only be supplied on a valid prescription from a registered medical practitioner.

Scope of practice — Singapore optometrists

Under the Optometrists and Opticians Act (Cap. 213A) and regulations administered by the Optometrists and Opticians Board (OOB), Singapore-registered optometrists are authorised to examine eyes, assess visual function, and prescribe optical appliances. They do not have the authority to prescribe, supply, or administer therapeutic medications, including POM dry eye agents (cyclosporine, corticosteroids). Optometrists may recommend and guide patients toward appropriate OTC lubricants, but must refer any patient requiring POM treatment to a registered medical practitioner.^[4,5]

General Sale (OTC): The majority of artificial tear lubricants — including polyethylene glycol (Systane Ultra, Systane Balance), carboxymethylcellulose (Refresh Tears), sodium hyaluronate (Hylo-Forte, Hycosan), and lubricant ointments (Lacrilube) — are available without prescription at Guardian, Watsons, Unity, and major supermarkets.
Prescription-only (POM): Cyclosporine ophthalmic emulsions (Restasis 0.05%, Ikervis 0.1%) and all topical corticosteroids used in DED management (fluorometholone, loteprednol) are POM. Singapore optometrists detecting inflammatory DED or treatment-refractory symptoms must refer to an ophthalmologist for these agents.
Hospital formularies: Cyclosporine 0.05% and 0.1%, loteprednol 0.5%, and autologous serum drops are available through public eye centre pharmacies following ophthalmologist prescription. Autologous serum is a specialist-only preparation requiring blood processing at licensed facilities — not commercially available.
Private ophthalmology clinics: POM dry eye agents are prescribed and dispensed at private ophthalmic clinics. Ongoing lubricant supplies may be purchased OTC; cyclosporine and steroids require renewal prescriptions from the treating doctor.
HSA product verification: Current product registration status for all dry eye agents can be verified via the HSA product registration portal (hsa.gov.sg). Always confirm registration before recommending or referring for a specific product.^[4]

Why use topical agents for dry eye?

Topical dry eye drops deliver therapeutic agents directly to the ocular surface — the site of pathology — providing rapid symptom relief and measurable improvements in tear film stability, TBUT, and ocular surface staining with minimal systemic exposure. Targeted topical delivery is both more effective and substantially safer than systemic alternatives for the management of ocular surface disease.

Direct ocular surface delivery

High local drug concentration at the tear film and cornea; superior to oral options for ocular-specific outcomes.

Minimal systemic exposure

Negligible systemic absorption for lubricants; cyclosporine topical levels are sub-therapeutic systemically — safe for long-term use.

Rapid symptom relief

Lubricants provide immediate symptomatic relief within minutes of instillation — important for patient comfort and compliance.

Flexible step-up approach

OTC lubricants allow self-management; POM immunomodulators can be added for refractory cases without discontinuing the lubricant base.

Oral omega-3 fatty acid supplementation (EPA/DHA) has adjunctive evidence in MGD-associated DED and may be recommended by optometrists as a non-prescription adjunct. However, topical drops remain the primary therapeutic modality. For severe aqueous-deficient DED (especially Sjögren's syndrome), systemic secretagogues (pilocarpine, cevimeline) may be considered by a treating physician alongside topical therapy.^[6]

How to use dry eye drops — patient instructions

Instillation technique

Wash hands thoroughly with soap and water before handling the bottle or touching the eye area.
Tilt head back slightly and gently pull down the lower eyelid to form a small pocket (lower fornix).
Hold the bottle inverted above the eye and instil one drop into the lower fornix — do not allow the bottle tip to touch the eye, eyelid, or eyelashes to avoid contamination.
Gently close the eye and apply nasolacrimal occlusion (fingertip to the inner corner of the eye) for 1–2 minutes to maximise ocular retention and minimise drainage.
If using more than one type of drop, wait at least 5 minutes between each preparation to prevent dilution and washout of the first agent.
Recap the bottle immediately after use; store as directed (most OTC lubricants at room temperature). Discard single-use vials after each use; multi-dose preservative-free bottles (e.g., COMOD system) should be used within the manufacturer's recommended period after opening.

Contact lens guidance

Preservative-free lubricants (unit-dose vials or COMOD bottles such as Hylo-Forte and Hycosan) are safe to instil while wearing soft contact lenses — no waiting period required.
BAK-preserved lubricants (e.g., Refresh Tears multi-dose) must be instilled at least 15 minutes before lens insertion. Prolonged use of preserved drops in lens wearers is not recommended — switch to preservative-free alternatives.
Lipid emulsions (Systane Balance) and ointments (Lacrilube) are not compatible with contact lens wear — instil only after lens removal.
During acute DED flares with significant corneal staining or discomfort, cease contact lens wear until the ocular surface has stabilised — confirmed by repeat slit-lamp assessment.

Monitoring and red-flag referral

All patients: Review at 4–6 weeks to assess symptom control, TBUT, and corneal staining (Oxford scale). Escalate if no improvement.
Contact lens wearers: Assess corneal staining, TBUT, and papillary response at each visit; consider daily disposable CL or reduced wearing time if DED worsens.
Steroid users (co-prescribed): IOP check at 2 and 4 weeks. Discontinue if IOP rises >5 mmHg above baseline or exceeds 21 mmHg; refer urgently.
Red flags requiring urgent ophthalmology referral: Corneal ulcer or infiltrate, sudden decrease in visual acuity, severe photophobia, filamentary keratitis, mucous plaques, or symptoms unresponsive to 6 weeks of optimised OTC therapy.

Common dry eye drops in Singapore

All agents listed are, or have been, registered with HSA Singapore or are available through registered importers. Verify current product registration at hsa.gov.sg before recommending or referring for any specific product.

Brand (Generic)	Mechanism	Dosing	Min. Age	Side Effects	Clinical Notes
Systane Ultra Polyethylene glycol 0.4% + propylene glycol 0.3% OTC	Aqueous lubricant — polymer film stabilisation	1–2 drops PRN or QID	≥3 years	Transient blurring, mild stinging on instillation	First-line for mild-moderate dry eye; widely available OTC at major pharmacy chains
Refresh Tears Carboxymethylcellulose 0.5% OTC	Aqueous lubricant — CMC polymer viscosity enhancement	1–2 drops PRN	≥3 years	Transient blurring, mild stinging; BAK preservative may accumulate on soft CL	Widely available OTC; switch to preservative-free formulation if using >4× daily
Hylo Comod Sodium hyaluronate 0.1% OTC	Aqueous lubricant — HA viscoelastic film; tear film stabilisation	1 drop TID–QID; preservative-free COMOD bottle	All ages	Minimal; occasional transient blurring	Preservative-free; CL-compatible; suitable for mild-moderate dry eye and lens comfort
Systane Balance Propylene glycol 0.6% + LipiTech lipid emulsion OTC	Lipid-containing emulsion — replenishes lipid layer; reduces evaporation	1–2 drops BD–QID	≥3 years	Transient blurring post-instillation; mild stinging	First-line for evaporative dry eye / MGD; remove contact lenses before use
Restasis Cyclosporine 0.05% ophthalmic emulsion POM	Calcineurin inhibitor — reduces T-cell mediated ocular surface inflammation	1 drop BD (both eyes); onset 3–6 months	≥16 years	Burning/stinging on instillation, ocular discomfort, photophobia	For moderate-severe inflammatory dry eye; long-term use; ophthalmologist prescribing only
Ikervis Cyclosporine 0.1% cationic emulsion POM	Calcineurin inhibitor — cationic emulsion enhances corneal penetration	1 drop OD at bedtime	≥18 years	Instillation site pain/burning (frequent initially), lacrimation, blurred vision	Once-nightly dosing; for severe keratitis-associated dry eye; ophthalmologist only
FML Fluorometholone 0.1% POM	Corticosteroid (mild) — anti-inflammatory; reduced IOP-raising risk vs. prednisolone	1–2 drops BD–QID; taper as required	≥2 years (with supervision)	Raised IOP, cataract risk, secondary infection with prolonged use	Short-course only for acute inflammatory exacerbations; IOP monitoring mandatory

Legend

POMPrescription Only Medicine — Sold or supplied to the public on prescription only.

PPharmacy Medicine — Sold or supplied from any licensed retail pharmacy under pharmacist supervision.

OTCGeneral Sales List (GSL) — Sold or supplied to the public without restriction.

Dosing reflects standard adult doses unless noted. Always refer to the approved product insert for full prescribing information. PRN = as needed, BD = twice daily, TID = three times daily, QID = four times daily, OD = once daily, nocte = at night.

References

[1] Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II Definition and Classification Report. Ocul Surf. 2017;15(3):276–283. PMID: 28736335.
[2] Tong L, Waduthantri S, Wong TY, et al. Impact of symptomatic dry eye on vision-related daily activities: the Singapore Malay Eye Study. Eye (Lond). 2010;24(9):1486–1491. PMID: 20379227.
[3] Tong L, Saw SM, Lamoureux EL, et al. A questionnaire-based assessment of symptoms associated with tear film dysfunction and lid margin disease in an Asian population. Ophthalmic Epidemiol. 2009;16(1):31–37. PMID: 19191184.
[4] Health Sciences Authority Singapore. Medicines Act (Cap. 176). Singapore Statutes Online. Available at: sso.agc.gov.sg (accessed March 2026).
[5] Republic of Singapore. Optometrists and Opticians Act 2007 (No. 16 of 2007). Singapore Statutes Online. Available at: sso.agc.gov.sg/Act/OOA2007 (accessed March 2026).
[6] Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575–628. PMID: 28736343.
[7] Sall K, Stevenson OD, Mundorf TK, Reis BL. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. Ophthalmology. 2000;107(4):631–639. PMID: 10768324.
[8] Leonardi A, Van Setten G, Amrane M, et al. Efficacy and safety of 0.1% cyclosporine A cationic emulsion in the treatment of severe dry eye disease: a multicenter randomized trial. Eur J Ophthalmol. 2016;26(4):287–296. PMID: 26914870. (Ikervis/SANSIKA)
[9] Bron AJ, de Paiva CS, Chauhan SK, et al. TFOS DEWS II Pathophysiology Report. Ocul Surf. 2017;15(3):438–510. PMID: 28736337.
[10] Tsubota K, Yokoi N, Shimazaki J, et al. New Perspectives on Dry Eye Definition and Diagnosis: A Consensus Report by the Asia Dry Eye Society. Ocul Surf. 2017;15(1):65–76. PMID: 27725302.

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