INTRODUCTION: The tear film is part of the ocular surface and forms a highly complex interface between the corneal and conjunctival epithelium and the environment. As a key refracting surface, it is essential in maintaining clear vision, as well as supporting the health and integrity of the entire ocular surface.

AREAS COVERED: This review describes the structure and stability of the tear film, a complex, dynamic, trilayered combination of mucins, aqueous components, and lipids. It discusses how loss of this stability leads to inflammation, ocular surface damage, eye dryness, and discomfort that can significantly impair vision and quality of life. Finally, it summarizes the current and future state of dry eye disease (DED) management. Over-the-counter artificial tear eye drops remain a therapeutic cornerstone and represent part of first-line therapy for most patients. Artificial tears are typically multi-component formulations and differ in their active ingredients, preservative content, electrolytes, vehicle formulation, and concentration and consistency.

EXPERT OPINION: A nuanced, phenotype-driven approach to artificial tear selection, rather than viewing tear substitutes as interchangeable therapies, is necessary. Clinicians should aim to align formulation characteristics with disease etiology, symptom profile, lifestyle factors, and patient preferences to achieve more specific targeted disease management.