PURPOSE: To synthesize and contextualize recent evidence on over-the-counter (OTC) artificial tears (AT) for dry eye disease (DED), focusing on how ingredient and delivery innovations target tear-film instability, hyperosmolarity, inflammation, and evaporation; and how formulation choice can be individualized within the TFOS DEWS III management framework.

SETTING: This context for this analysis is the eye-care practice where DED is managed as a chronic, multifactorial ocular surface disorder. The scope emphasizes first-line, widely accessible OTC tear supplementation and patient lifestyle/environmental triggers.

METHODS: TFOS DEWS III guidance and peer-reviewed literature on tear-film structure and AT performance were reviewed. Evidence was qualitatively synthesized across formulation classes (polymer demulcents/viscosity enhancers, osmoprotectants, lipid emulsions/liposomes, antioxidant/vitamin additives, and preservative or preservative-free delivery systems) and mapped to DED phenotypes and practical use considerations.

RESULTS: ATs are foundational in DED, but formulations are not interchangeable. Polymer demulcents/viscosity enhancers (eg, carboxymethylcellulose, hydroxypropyl methylcellulose, hyaluronic acid, hydroxypropyl guar) increase lubrication and retention. Osmoprotectants (trehalose, erythritol/L-carnitine, ectoine, glycerol) counter hyperosmolar stress. Lipid-based systems (oil emulsions, phospholipid nanoemulsions, liposomal sprays) replenish the lipid layer for evaporative DED/meibomian gland dysfunction, but with possible transient blur. Antioxidant/vitamin additives (vitamin A or B12) have emerging evidence. Combination drops blend classes to target multiple mechanisms. Preservative-free or “vanishing” preservatives are favored for frequent dosing.

CONCLUSIONS: A patient-centered approach that links DED phenotype and triggers to AT formulation (aqueous-supporting polymers, hyperosmolarity-targeting osmoprotectants, and lipid supplementation for evaporative disease) can improve comfort and long-term control. Clinicians should consider preservative exposure, dosing burden, bottle usability, contact-lens wear, and cost to maximize adherence. Future well-designed comparative studies using consistent DED definitions and outcomes are needed to define optimal ingredient combinations, concentrations, and dosing strategies.