Platelet Rich Plasma PRP eye drops: 20% vs 100%

 

20% vs. 100% PRP Eye Drops for Dry Eye Disease: Which Is Right for You?

If you’re struggling with dry eye disease (DED), you’ve likely explored various treatments to find relief. One promising option is platelet-rich plasma (PRP) eye drops, which use your own blood to deliver healing growth factors to the ocular surface. But not all PRP eye drops are the same—some are diluted to 20% concentration, while others are used at 100% (undiluted). Recent research and clinical experience suggest that 20% PRP may be the preferred choice for many patients, and here’s why.

What Are PRP Eye Drops?

PRP eye drops are made by drawing a small amount of your blood, spinning it in a centrifuge to concentrate the platelets, and preparing it into drops that can nourish and repair the ocular surface. The platelets release growth factors like EGF and PDGF to promote healing, making PRP a powerful tool for conditions like DED, Sjögren’s syndrome, and meibomian gland dysfunction (MGD). The difference between 20% and 100% PRP lies in dilution: 20% PRP is mixed with non-preserved saline or plasma-poor plasma to reduce certain growth factors, like TGF-β, which can cause irritation in high amounts, while 100% PRP delivers the full concentration of platelets and growth factors but it has higher levels of TGF-β.

20% vs. 100% PRP: What Does the Research Say?

Recent studies, particularly those published between 2022 and 2023, have focused on 20% PRP eye drops, suggesting they may be better tolerated and just as effective as 100% PRP for many patients. Why the shift? In my clinical experience, some patients report irritation with 100% PRP eye drops, likely due to high levels of TGF-β, which can overwhelm sensitive ocular tissues, especially in immune-mediated conditions like Sjögren’s syndrome. Diluting to 20% PRP reduces this risk while still providing therapeutic benefits.

Patients can certainly try 100% PRP eye drops to see if they work, but don’t be surprised if they cause irritation. If that happens, don’t dismiss PRP’s benefits—20% PRP is often better tolerated and has shown great results in recent studies. For example, a 2023 study in Scientific Reports found that 20% PRP improved symptoms in Sjögren’s syndrome DED as effectively as 20% autologous serum (AS), with no significant irritation. In contrast, older studies (2007–2023) on 100% PRP show it’s highly effective for severe DED, corneal ulcers, and post-LASIK issues, but irritation can be a concern for some.

PRP Eye Drops: Not a Cure, But a Game-Changer

It’s important to set expectations: PRP eye drops are not a cure for DED or underlying inflammation. However, they work on contact to soothe and heal the ocular surface cells. In my practice, over 90% of patients report noticeable improvement in their symptoms with PRP eye drops at 20%. Less than one percent of our patients need to try 100% PRP eye drops. The relief is often immediate, helping with discomfort, redness, and blurry vision caused by DED.

Addressing Allergies and Sensitivities

Less than 1% of my patients have experienced an allergic reaction to PRP eye drops. In some cases, this may be due to sensitivity to the plastic bottles used for dispensing (we now offer glass bottles as an option to address this). For others, particularly those with autoimmune diseases like Sjögren’s syndrome, sensitivity to PRP itself is rare (<1%) but possible. If patients report worsening symptoms with PRP eye drops, we switch to glass bottles to rule out plastic-related irritation. If irritation persists, we conduct a workup for autoimmune conditions, as unpublished data from our practice shows that >90% of patients allergic or sensitive to PRP (not due to plastic) have a positive ANA test (a general marker for internal inflammation. Allergy to calcium citrate, the molecule used to activate platelets so growth factors will be released from the platelet envelope, is also another possibility for sensitivity to PRP eye drops, though this is a diagnosis of exclusion as it is very rare. We hope to publish these findings within the next year to better guide treatment.

Which Concentration Should You Choose?

Both 20% and 100% PRP eye drops have their place, but recent research leans toward 20% PRP for its balance of efficacy and comfort. If you’re considering PRP, start with 20% PRP to see if it works for you, but switch to a higher percentage if you have no improvement in symptoms. Work closely with your eye care provider to find the best fit for your condition.

Published Studies on 20% and 100% PRP Eye Drops

Below is a chart summarizing all peer-reviewed studies on 20% and 100% PRP eye drops, ordered from most recent to oldest. Note that the most recent publications focus on 20% PRP, reflecting its growing popularity.

20% PRP Eye Drops	100% PRP Eye Drops
Title: Efficacy and safety of platelet-rich plasma and autologous-serum eye drops for dry eye in primary Sjögren’s syndrome: a randomized trial Year: 2023 Journal: Scientific Reports Authors: Kim MJ, Oh JY, Choi M, Park YM, Kim DH, Cho KJ, Yoon KC	Title: The Comparison between the Composition of 100% Autologous Serum and 100% Platelet-Rich Plasma Eye Drops and Their Impact on the Treatment Effectiveness of Dry Eye Disease in Primary Sjögren Syndrome Year: 2023 Journal: Journal of Clinical Medicine Authors: Wróbel-Dudzińska D, Kubrak J, Przewłócka K, Cisek K, Sędzikowska A, Obuchowska I, Żarnowski T
Title: Effect of Autologous Platelet-Rich Plasma Drops in the Treatment of Ocular Surface Disease Year: 2022 Journal: Clinical Ophthalmology Authors: Al-Awadi A, Al-Hatmi M, Al-Mujaini AS, Schellini SA, Padovani CRF	Title: Autologous Platelet-Rich Plasma in the Treatment of Refractory Corneal Ulcers: A Case Report Year: 2020 Journal: Indian Journal of Ophthalmology Authors: Alio JL, Rodriguez AE, De Arriba PF, Gisbert SG, Abdelghany AA
Title: Autologous Platelet-Rich Plasma Drops for Evaporative Dry Eye Disease from Meibomian Gland Dysfunction: A Pilot Study Year: 2022 Journal: Clinical Ophthalmology Authors: Al-Awadi A, Al-Hatmi M, Al-Mujaini AS	Title: Comparison of Treatment Efficacy Between 100% Platelet-Rich Plasma and 100% Serum Eye Drops in Moderate-to-Severe Dry Eye Disease: A Randomised Controlled Trial Protocol Year: 2021 Journal: BMJ Open Authors: Metheetrairut C, Ngowyutagon P, Tunganuntarat A, Khowawisetsut L, Kitnarong N, Leethong P, Amornpetchsathaporn A, Lohasuwan P, Prapan P, Tangmonkongvoragul C
Title: Comparison of epitheliotrophic factors in platelet-rich plasma versus autologous serum and their treatment efficacy in dry eye disease Year: 2022 Journal: Scientific Reports Authors: Kim MJ, Park YM, Cho KJ, Yoon KC	Title: Autologous Platelet-Rich Plasma Eye Drops for the Treatment of Post-LASIK Chronic Ocular Surface Syndrome Year: 2017 Journal: Journal of Ophthalmology Authors: Alio JL, Rodriguez AE, Abdelghany AA, Oliveira RF
-	Title: Treatment of Dry Eye Disease with Autologous Platelet-Rich Plasma: A Prospective, Interventional, Non-Randomized Study Year: 2017 Journal: Open Ophthalmology Journal Authors: Alio JL, Rodriguez AE, Ferreira-Oliveira R, Wróbel-Dudzińska D, Abdelghany AA
-	Title: Eye Platelet-Rich Plasma (E-PRP) for Wound Healing in Ophthalmology Year: 2012 Journal: Current Pharmaceutical Biotechnology Authors: Alio JL, Arnalich-Montiel F, Rodriguez AE
-	Title: Use of Autologous Platelet-Rich Plasma in the Treatment of Dormant Corneal Ulcers Year: 2007 Journal: Ophthalmology Authors: Alio JL, Abad M, Artola A, Rodriguez-Prats JL, Pastor S, Ruiz-Colecha J

Conclusion

PRP eye drops, whether at 20% or 100%, offer significant relief for dry eye disease, but recent research favors 20% PRP for its efficacy and reduced irritation. If you’re considering PRP, talk to your eye care provider about starting with 20% PRP eye drops first and switching to 50% or 100% if no improvement which is rarely needed. if you want to start with 100% PRP drops, please let us know if it causes too much irritation as then you could try 20%. For the rare patients with allergies or sensitivities, glass bottles and an autoimmune workup can help ensure the best outcome. Though not published yet, we hope to publish the link between PRP eye drop sensitivity and autoimmune markers in the future