Mechanism-Based Selection of Artificial Tears in Dry Eye Disease: A Practical Clinical Framework

Artificial tears are commonly used as initial therapy for dry eye disease (DED), but the increasing number of available formulations makes product selection challenging. Current DED management emphasizes identifying the patient's predominant etiological contributors and tailoring treatment accordingly. However, ocular lubricants are often selected empirically, despite substantial differences in their ingredients, formulation technologies, preservative systems, and therapeutic actions. This narrative review examines artificial tear formulations through a clinically oriented, mechanism-based lens. Major categories include viscosity-enhancing polymers, osmoprotectants, lipid-containing emulsions, hyaluronic acid-based lubricants, epithelial protective formulations, gels, ointments, and water-free anti-evaporative formulations. Representative commercial products are included to illustrate formulation diversity; these examples are not intended as an exhaustive list or product endorsement. A practical framework is proposed to align lubricant selection with predominant tear film, eyelid, and ocular surface abnormalities while recognizing that mixed disease often requires combination or alternating lubricant therapy and management beyond tear substitutes. This framework supports TFOS DEWSIII–aligned individualized care but is not a validated treatment algorithm. Prospective comparative studies are needed to determine whether mechanism-guided lubricant selection improves clinical outcomes.