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Autologous Serum Eye Drops: Indications, Step-by-Step Preparation, 20% vs 50%, Storage and Safety

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Autologous Serum Eye Drops: Indications, Step-by-Step Preparation, 20% vs 50%, Storage and Safety

Last updated: November 2026

Serum contains growth factors (EGF, TGF-β, nerve growth factor), vitamin A and fibronectin that support corneal epithelium, much like natural tears. Autologous serum drops are made from the patient's own blood and are used when ordinary lubricants fail. Preparation methods vary; this page gives the most widely used protocol and the points that keep the drops safe.

Indications

  • Severe aqueous-deficient dry eye (e.g. Sjögren syndrome, graft-versus-host disease) not controlled with preservative-free lubricants.
  • Persistent epithelial defects and recurrent erosions.
  • Neurotrophic keratopathy.
  • Ocular surface disease after chemical injury, Stevens-Johnson syndrome or limbal stem cell deficiency.

Avoid or take care with anaemia or poor venous access, active systemic infection, and in patients with blood-borne infections (HIV, hepatitis B or C): screening is usually done before preparation, and many units do not prepare drops for infected patients because of handling risk to staff.

Preparation step by step

Most widely used protocol (adapt to your unit and blood bank)

  1. Consent and screening blood tests as per protocol.
  2. Collect blood aseptically into sterile plain tubes without anticoagulant (volume depends on the number of bottles needed; small batches often use 40–100 mL).
  3. Let the blood clot at room temperature for about 2 hours.
  4. Centrifuge at about 3000 × g for 15 minutes.
  5. Under laminar flow, draw off the clear serum without disturbing the clot.
  6. Dilute with preservative-free normal saline or balanced salt solution: 20% (1 part serum + 4 parts diluent) for most patients, 50% for severe disease.
  7. Divide into small sterile dropper bottles (one bottle per day or few days); label with name, date and "for this patient only".
  8. Freeze the unopened bottles; keep one in the fridge for use.

Storage

StageTemperatureDuration (typical)
Unopened, frozen−20°C (some units −80°C)Up to about 3 months at −20°C; longer at −80°C
In use (thawed)4–8°C (fridge)Up to about 1 week; discard sooner if cloudy
NeverRoom temperature for long periods, or refreezing—

Teach the patient to wash hands, avoid touching the tip, keep the bottle in the fridge, and use a fresh bottle as instructed. Typical use is 4 to 8 times a day.

Problems

  • Contamination: the drops have no preservative; bacteria have been grown from used bottles. Use small bottles and short in-use times.
  • Discomfort or immune deposits are uncommon.
  • Cost and logistics: repeated blood draws and cold storage.
  • Alternatives: platelet-rich plasma drops, umbilical cord serum, allogeneic serum, and commercial growth factor products (e.g. cenegermin for neurotrophic keratopathy).

Pearls

  • 20% serum is 1 part serum to 4 parts preservative-free saline.
  • Small bottles and short in-use time are the main defence against contamination.
  • Keep the in-use bottle in the fridge and freeze the rest.

Common mistakes

  • Using a preserved diluent.
  • Large bottles used for weeks.
  • Preparing without screening or laminar flow.

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Related: TFOS DEWS III: What Changed in Dry Eye Diagnosis and Treatment, Dry Eye Treatment in Ahmedabad, Cornea, Fibrin Glue for Pterygium Autograft: Reliseal, Fibroseal and Tisseel Compared, Preparation and Technique, Bandage Contact Lenses and Punctal Plugs: Indications, Choosing the Size and Type, Fitting and Follow-Up.

Key sources

  • Autologous serum eye drops in dry eye disease: preferred practice pattern guidelines. Indian J Ophthalmol. 2023;71:1357-1363
  • Optimising autologous serum tear therapy for dry eye disease: strategies and innovations (review, PMC12898137)
  • Geerling G, Maclennan S, Hartwig D. Autologous serum eye drops for ocular surface disorders. Br J Ophthalmol. 2004;88:1467-1474
  • TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15:575-628

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Written and medically reviewed by Dr. Dhaval Patel, MD (Ophthalmology, AIIMS New Delhi) · Editorial policy

Consultant, Cataract & Refractive Surgery — among a small number of AIIMS-trained ophthalmologists practicing in Gujarat. Read full credentials & experience or view his 28 publications on ResearchGate.

📚 Also the author of OKAT Decoded, FRCOphth Decoded and other high-yield ophthalmology exam-prep books used by residents and PG aspirants.

Looking for an eye specialist in Ahmedabad? Dry eye care at Sadbhaav or book a consultation with Dr. Dhaval Patel.

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