Let's take a break from talking about contact lenses for a bit. After all, not everyone wears contact lenses. But a more common issue I find patient's are using more often (ever since our government has make decided to make marijuana legal.... and no, I can't prescribe it) are OTC eye whitener products. Since patients need to hide their red eyes more often lately, I find myself asking in the exam room if they are using these products regularly. I think you already get the sense they are not my favorite OTC eye drops, but before I tell you my opinion, lets actually find out how these products work.
It's not that scientific, these eye drops act to reduce the redness by constricting the blood vessels on the whites of our eyes. But specifically they act by holding onto (and reducing the effects of) the alpha 1 receptors on arterioles. Arteries carry oxygen in the blood to surrounding cells and when they are constricted, then obviously the cells are getting less oxygen. But as this continues to occur, the body starts reacting to the less oxygen it is getting by creating more blood vessels and thus (you guessed it) you need more of the eye drop to obtain the same effect. This causes a "rebound effect" where the eye becomes more red since the body is not reacting to the drug the same as when you started using it. Easy solution right? Just keep using it but more often! Well the problem with that is the preservatives in any eye drop, including the ones over the counter, end up being more toxic to the eyes after more than 4 times per day. This is why I typically try to steer my patients away from these OTC eye drops.
This is when I would typically tell patients to wean off these products without any alternative other than trying to find the root cause of their redness. But if we are lucky, there should be a new product to come into our Canadian market that not only does the same thing as these "get the red out" products, but without the negative side effects. A Bausch and Lomb product called Lumify was F.D.A. approved in 2017 in the U.S. Its method of action is instead of choking off the oxygen to your eye tissues, it only constricts the alpha 2 receptors on veins (blood vessels that do not carry oxygen), therefore not causing the same rebound redness. In a randomized clinical study involving 60 participants, they found that subjects noted minimal rebound reaction after discontinuing the product after 4 weeks of use. It showed a low risk of allergy and minimal adverse effects after instillation (since the active ingredient is at such a low, 0.025% concentration).(1)
Since this is such a new drug we must be cautiously optimistic about using it especially as new studies come out every month about its long term effects. However I cannot wait until the day that this does (and it will) become approved by Health Canada. Finally we will be able to help those that still suffer from red eye even after treating their underlying allergy, or after a long day of contact lens wear or after working an 8 hour shift in a toxic environment. Hopefully this will wipe out all the other OTC whitening products or at least get them to generate a more safe long term product for patients.
To a healthy visual field,
Dr. Michael Yee, Optometrist
(1) McLaurin E1, Cavet ME2, Gomes PJ, Ciolino JB3.
Brimonidine Ophthalmic Solution 0.025% for Reduction of Ocular Redness: A Randomized Clinical Trial.Optom Vis Sci. 2018 Mar;95(3):264-271. doi: 10.1097/OPX.0000000000001182.