Purpose: To investigate the cell survival of human conjunctival goblet cells (CGs) when incubated with preserved and preservative-free (PF) artificial tears (AT) used against dry eye disease (DED). The following ATs were tested: 0.011% benzalkonium chloride (BAK)-preserved Viskøse Øjendråber, 0.006% BAK-preserved Oftagel, 0.005% BAK-preserved Oculac, 0.001% PolyQuad-preserved Systane Ultra, 0.01% Cetrimide-preserved Artelac, and PF ATs: Systane Ultra, Oculac, Oftagel, and Thealoz Duo.

Method: Primary cultures of human conjunctival CGs were cultivated from donor conjunctiva. After incubation with said ATs for 2 hours, CG survival was analysed using a lactate dehydrogenase assay and calculated to a negative control.

Results: AT preserved with 0.011% BAK reduced GC survival by 28% compared to negative control (p=0.001). The remaining ATs did not significantly alter the cell survival.

Conclusion: BAK-preserved ATs cause GC death in a concentration-dependent manner. Reduction of the GC density may contribute to the development of DED. PF-ATs and PolyQuad- and Cetrimide-preserved ATs may thus be a better choice for treating DED than BAK-preserved ATs, as the latter may add to ocular surface disease.