Artificial Tears on Shabbos

Chukat 5779

“…The waters of the eye are salty. The waters of the ear are fatty. The waters of the nose are disgusting. The waters of the mouth are sweet. Why were the waters of the eye created salty? For when a person cries constantly over a person who has died, he would immediately become blind, but since the water (of his tears) is salty, he stops crying.” (Medrash Tanchuma, Chukas)

The “waters of the eye”, i.e. tears, are essential to the health of the eyes. Tears ensure that the eyes stay free of dust, wash away foreign bodies that enter the eyes, and help to protect against infection.

A common question is whether it is permitted to use artificial tears on Shabbos. Though the phenomenon of dry eyes might appear to be little more than an annoyance, it can also be due to an underlying autoimmune disease or infection. If untreated, dry eyes may result in damage to the eye such as infection and corneal abrasion or laceration. In most cases, the treatment is to instill artificial tears (eye drops). This helps to relieve the symptoms and prevent the development of complications. However, the drops do not cure the underlying disease or condition that caused the dry eyes in the first place.

This essay will discuss the Halachic issues that determine whether artificial tears may be used on Shabbos in terms of both relieving discomfort and preventing possible damage to the eyes.

The principle reason that Refua is prohibited on Shabbos (except in cases of serious or dangerous illness) is “Shechikas Samemanim” – grinding of herbs for medications. Chaza”l were concerned that a person may forget that grinding is forbidden on Shabbos (or that it is indeed Shabbos) in the haste to prepare the medicine and violate an Issur Torah.

Chaza”l’s prohibition does not just apply to medications that cure or treat illnesses, but also to the treatment of pain or discomfort. It is therefore forbidden to swallow vinegar to relieve a toothache or take pain-relieving medication for a minor headache.

Regarding the treatment of the eye on Shabbos the Shulchan Aruch (O.C. 328:20) rules:

“One may not place wine into the eye on Shabbos. As for placing it above the eye – if one then opens and closes the eye (to allow the wine to drip into it) – it is forbidden, but if one does not open and close it – it is permitted. And ‘Rok Tafeil’ (saliva of a person who hasn’t eaten since awakening[1]) may not be placed above the eye in any circumstances because it is obvious that one is doing so for the purposes of Refua.”

The Poskim do not explain precisely what the purpose of wine or Rok Tafeil is, but it is highly probable that it is for the treatment of dry eyes.  If so, then we have a clear indication that the treatment of dry eye on Shabbos is considered Refua and is therefore forbidden.

However, the Magen Avraham (and other Poskim) quote an interesting ruling of the Maharsha”l who permitted moistening one’s eyes with Rok Tafeil if one is unable to open them because the intention is only to help open his eyes, not to effect a cure.

Difficulty with opening the eyes is often a sign that a person is suffering with dry eyes. If so, we could argue, that just as Rok Tafeil is permitted to enable a person to open his eyes (as doing so is not considered Refua), we should also permit the use of artificial tears as they too just relieve his uncomfortable symptoms and do not effect an actual Refua.

However, there is a difference between the two cases. Artificial tears do actually resolve the problem of dry eyes in a real sense. Though they do not cure the underlying problem in a medical sense, they do genuinely eliminate the feeling of dryness in the eyes. Therefore, their use could be construed as Refua[2]. On the other hand, moistening the eyes with Rok Tafeil, is a one-off, specific act to help open the eyes.  Doing so does not resolve any issues and therefore does not resemble Refua at all.

At any rate, the permissibility of using artificial tears on Shabbos depends upon the level of dryness of the eye. If a person is not experiencing any particular pain in his eyes and he only wants to feel more comfortable, it is likely that he may use artificial tear drops as they do not effect any type of Refua. However, if due to the dryness he has pain or discomfort, using the drops may be forbidden as they do “cure” his discomfort and it is considered Refua.

What about the desire to prevent damage to one’s eye? Could that be the grounds for leniency in using artificial tears on Shabbos?

In general, Chaza”l were very concerned about diseases or injuries of the eye. They considered them to be Sakanas Nefashos as they were said to be the cause of diseases of the heart and are therefore a danger to the entire body, not just the eyes (Avodah Zarah 28b). For this reason, the smallest eye infection may be treated on Shabbos (Shemiras Shabbos Kehilchasa 34:8). However, many Poskim write that slight pain in one’s eyes is not considered to be an illness at all, let alone Sakanas Nefashos. One therefore may not take any form of medication to relieve the pain. (See Mishna Berurah ibid. 64)

It would seem that even if a person’s eyes are very dry indeed, he may not use artificial tear drops on Shabbos, even for the purpose of preventing damage to his eyes, assuming that the temporary withholding of artificial tears for just the twenty-four period of Shabbos will not put his eyes at any great risk.

Some clarification is in order: If somebody was already sick before Shabbos, though he is not currently in any danger, he may continue to take his medications on Shabbos, even if he will not be at any risk by waiting until Shabbos is over (Rav Shlomo Kluger zt”l, Sefer ha’Chaim 328). Moreover, if a person will become ill (to the degree that he would take to bed) if he doesn’t take his medication, even though he is not ill right now, he is permitted to take the medication on Shabbos. Nevertheless, in the case of dry eyes, since the person is not currently ill in any way and will not put himself in any danger of becoming ill if he refrains from using eye drops until Shabbos is over, there is no room to be lenient.

In a Shiur on this topic, Rav Yitzchak ha’Kohen Rubin Shlit”a[3] raised the possibility that if a person was advised by a doctor to begin using eye drops before Shabbos out of a concern that his eyes may become infected without them, he may continue using them on Shabbos[4]. He hesitates to rule this way in practice because it is a Chiddush to say that someone who is not yet actually a “Choleh” (as no infection has developed) may take medications on Shabbos (that would be an act of Refua) to prevent an illness from developing simply because he has begun taking a course of the medication.

In summary: Chaza”l forbade a person who is not a “Choleh” from taking medications on Shabbos, even to treat pain. Theoretically, an improvement in the condition of dry eyes seems to be considered Refua; therefore, using artificial tears would generally be forbidden. Even if a person used them regularly before Shabbos, he should avoid their use on Shabbos if there is no concern that damage to his eyes will ensue if he refrains from using them for a short period of time. However, a Rav or Posek should be consulted in actual specific cases.

[1] Some say that it has anti-infective properties.

[2] It is similar to placing vinegar on an aching tooth. Vinegar does not cure the underlying issue but does genuinely alleviate the pain. Doing so is therefore considered Refua by Chaza”l.

[3] Author of Orchos Shabbos

[4] Rav Rubin thought this to be true but did not rule it as Halacha le’Ma’aseh.