Eye Drop Review Part 3: Complete the Cycle with Systane Complete

Welcome back!

In our previous reviews, we've explored Systane Ultra as a reliable benchmark and Systane Hydration as an advanced solution. Now, we are turning our attention to Systane Complete and Systane Balance.

Here is a summary of the anatomy of the tear film.

Anatomy of the tear film: The tear film consists of 3 layers. The innermost layer is the mucin layer. This layer lies directly on the surface of the eye. It is a sticky layer that helps the aqueous layer to spread evenly across a hydrophobic cornea. The middle layer is the aqueous layer. This layer is composed primarily of water and is responsible for hydrating the corneal surface, removing foreign particles, and providing a smooth surface for light to pass through to the eye. The lipid layer is the outermost layer. This layer is produced by the meibomian glands located in the eyelids and forms an oily barrier that slows the evaporation of the aqueous layer underneath.

There are mainly two types of dry eyes, aqueous-deficient and evaporative. Previous reviewed drops (Systane Ultra, Systane Hydration and Systane Gel) mainly focus on replenishing the aqueous layer; therefore, it is mainly target patients with aqueous-deficient dry eyes. Unlike these drops, Systane Balance and Systane Complete contain an oil in the bottle, which targets the lipid layer too. Therefore, these tend to be useful for patients with meibomian gland dysfunction.

Systane Complete Product Information

• Active Ingredients: Polyethylene Glycol 400, Propylene Glycol, Hydroxypropyl Guar, Mineral Oil, Dimyristoyl Phosphatidylglycerol

• Non-active Ingredients: Boric Acid, Polyoxyl 40 Stearate, Sorbitan Tristearate, Sorbitol, Water

• Preservative: POLYQUAD™ (Polyquaternium-1) 0.001%, or in preservative-free single-use vials.

• Target Patients: Suitable for mild to moderate sufferers, especially those with both aqueous-deficient and evaporative dry eye (often associated with meibomian gland dysfunction).

• Contact Lenses: It is recommended to remove contact lenses before using this product.

As far as I can see, Systane Balance is almost the same as Systane Complete, except that it is only suitable for evaporative dry eyes.

Both Systane Complete and Systane Balance have added mineral oil and dimyristoyl phosphatidylglycerol, a phospholipid, to our group. However, oil and water don't dissolve in each other; instead, they form an emulsion (using emulsifying agents polyoxyl 40 stearate and sorbitan tristearate), which is basically a mixture where the oil is suspended in water in the form of oil droplets. An everyday emulsion we all use is mayonnaise.

The key difference between Systane Complete and Systane Balance is that Systane Complete uses a nano-emulsion technology, whereas Systane Balance uses a micro-emulsion technology. This simply means the droplets are smaller in Systane Complete compared to Systane Balance. So that's why when using Systane Balance, you would have to shake the bottle before instilling the drops. Furthermore, Systane Complete has a higher concentration of HP-Guar than Systane Balance. As discussed before, HP-Guar is excellent at lubricating the eye surface and retaining the drop on the eye for longer.

Preservative: Systane Complete is available preserved (with POLYQUAD®) and non-preserved. As stated before, I always recommend the preservative-free version whenever it is available. Systane Balance is only available preserved (with POLYQUAD®).

Our Verdict: A Comprehensive All-in-One Solution

Systane Complete is a comprehensive, all-in-one solution, and I believe it is better than Systane Balance in every way, at least for patients with evaporative dry eyes. For patients with aqueous-deficient dry eyes, Systane Complete may be similar to Systane Hydration. However, Systane Hydration contains Hyaluronate, which is better at healing damaged corneal tissue.

A Note from the Author

Looks like Alcon came out with a new Systane Eyedrop called Systane Pro PF, which is currently only available in the U.S.. It is basically a combination of Systane Complete and Systane Hydration. I do not have experience with this eyedrop as it is not available in Australia yet. Reading through the feedback on r/Dryeyes and people's responses were mostly "meh", with some preferring Systane Complete or other brands.

Thank you for taking the time to read my review. As an optometrist based in Australia, I aim to provide practical and well-researched information.

It is important to note that clinical studies on eye drops are usually funded by the company that makes them. Therefore, I encourage you to consider the findings with a discerning eye. More importantly, what works for one person might not work for another, and what doesn't work for you might work for someone else. Such is the nature of dry eye treatments.

This website is currently a work in progress, and I plan to add more visuals, including pictures and videos, and links to where you can purchase these products in the future. Please keep in mind that product names and availability may vary in your country.

References

• Alcon. (n.d.). SYSTANE® COMPLETE Lubricant Eye Drops. Retrieved from https://systane.myalcon.com/au/products/systane-complete/

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