Aims/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.

Methods: Primary cultures of human conjunctival CGs were cultivated from donor conjunctiva. After incubation with the above-mentioned ATs for 2 h, 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.

Conclusions: BAK-preserved ATs cause GC death in a concentration-dependent manner. Reduction of the GC density may contribute to 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 the ocular surface disease.