Darrell E. White, MD, is the founder of Skyvision Centers in Ohio. His blog for Ocular Surgery News will focus on issues related to dry eye disease.

BLOG: This stuff can kill ya – avoiding older ‘get the red out’ eye drops

For decades, eye doctors like me have been telling our patients not to use eye drops like Visine, Murine or Clear Eyes. These and other OTC medications have been used to “get the red out,” either chronically or after some episode that produced a marked change in appearance. My go-to statement has been to call all of these drops an example of “great marketing of a lousy product.” Now it’s even easier to steer people away from them.

“That stuff can kill ya!”

Earlier this year, the airwaves were full of accounts of the woman who caught her husband philandering and allegedly poisoned him by putting Visine or a similar product in his drinking water. Taken in large quantities, the active ingredient tetrahydrozoline is a neurotoxin that affects the sympathetic nervous system. It can result in everything from movement disorders (the husband allegedly died from falling down the stairs) to coma. Did you know this? I had no idea. Apparently, people have been poisoning each other with this stuff for years!

There really is a legit medical reason for us to steer our patients away from all “get the red out” eye drops, even those like Lumify that have few, if any, side effects. (No murders from Lumify, as of yet.) First and foremost is the issue of masking a clinical sign that needs to be investigated. People don’t get red eyes without a reason; chronic redness is a symptom that needs to be evaluated so that the underlying cause (DED, MGD, exposure, etc) can be identified and treated.

Of greater concern when discussing medications containing tetrahydrozoline is the tachyphylaxis that occurs at the receptor level in surface blood vessels. Over time, more and more medication is necessary to bring about the same effect. This also exposes a patient to larger doses of toxic preservatives, and when (if) the drop is discontinued, there can be a massive “rebound redness.” It is far better to identify and treat the pathology that causes the redness.

There are many different solutions under the brand umbrellas that are famous for “getting the red out,” and not all of them contain tetrahydrozoline. In my experience as a DED and red eye doc, they are all on the lowest rung of effectiveness. Patients are confused by the menu of choices and often as not opt for the version they are familiar with from marketing. It’s incredible how many folks come in for an initial consult using drops containing tetrahydrozoline. In my professional opinion, there are far better OTC options, and I will continue to suggest those.

At least until someone uses one of those to off somebody.

Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.