Preservatives in artificial tears: Assessing impact on dry eye symptoms: Findings from 67 951 questionnaire...

To examine the association between the presence of dry eye disease (DED) symptoms when using BAK-preserved artificial tears (AT) compared to preservative-free AT.

In this cross-sectional study, we used data collected as part of Project 'Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability' (FOREVER). To analyse the strength and direction of associations, we used binomial logistic regression models adjusted for age, sex, smoking and eye diseases. The analysis was conducted on responses regarding AT formulations and seven distinct DED symptoms from 67 951 participants in Project FOREVER, including 8039 AT users.

Our analysis showed statistically significant higher odds ratios (ORs) of experiencing itching and blurred vision among users of BAK-preserved AT compared to preservative-free AT users, with ORs of 1.26 (95% CI 1.01-1.58) and 1.28 (95% CI 1.02-1.60), respectively. Additionally, a borderline significant trend indicated an increased number of DED symptoms in the BAK-preserved AT group compared to preservative-free AT users. Furthermore, our study provided a comprehensive overview of AT usage patterns within the cohort, illustrating the proportion of users for each type of AT.

Our findings suggest that BAK-preserved AT may worsen DED symptoms. We found higher ORs for experiencing itching and blurred vision as well as a tendency towards experiencing a higher number of symptoms when using BAK-preserved AT compared to preservative-free AT. Further longitudinal studies with additional questions on AT usage and clinical assessments are needed to validate these findings and optimize AT formulations for safer, effective DED management.