Prescription Dry Eye Medications

Anti-inflammatory drops: cyclosporine and lifitegrast

Chronic dry eye is sustained by inflammation on the ocular surface, and these drops interrupt it. Cyclosporine, available as Restasis and Cequa, dampens the immune cells on the surface and, over months, increases tear production from a lacrimal gland that inflammation had suppressed. Lifitegrast, sold as Xiidra, blocks a specific step in the inflammatory cascade and can act somewhat faster. Both are used twice daily, take four to twelve weeks to show their full effect, and are continued long term. Stinging on instillation is common with cyclosporine at first and settles; lifitegrast can cause a temporary bitter taste. They are prescribed when the evaluation's MMP-9 test or surface findings show inflammation.

Steroid drops for flares

A short course of a mild steroid, such as loteprednol, brings an inflamed surface under control within days and is used to settle a flare or to bridge the weeks until cyclosporine or lifitegrast takes effect. Steroids are not used long term without supervision because of their effects on eye pressure and the lens, which is why they are prescribed in courses with follow-up.

Perfluorohexyloctane (Miebo)

A newer drop that contains no water: it spreads over the tear film as a thin layer that mimics the meibomian oil layer and slows evaporation. It suits evaporative dry eye from meibomian gland dysfunction and is used alongside gland treatment. It is preservative-free, though it may cause brief blurring after instillation.

Varenicline nasal spray (Tyrvaya)

A spray into the nose, not the eye, that stimulates the nerve pathway which triggers natural tear production, increasing the eye's own tears within minutes. It is used twice daily and suits patients with reduced production who find drops difficult, or as an addition to other treatment. Sneezing after use is common and harmless.

Other prescriptions

We offer a broad range of advanced treatment options. These include, but are not limited to, autologous serum eye drops, BlephEx, amniotic membrane/graft therapy and the latest punctal plug treatments. Treatment is customized according to your underlying condition and ocular surface needs.

Oral doxycycline or minocycline at low dose for rosacea related meibomian gland dysfunction. Lotilaner drops (Xdemvy) for demodex blepharitis. Autologous serum tears, made from the patient's own blood, for severe surface disease. Antibiotic ointments for bacterial blepharitis. Each is chosen for a specific finding at the evaluation.

Cost and coverage

These are prescription medications and coverage varies by plan and by drug, often with prior authorization or a preference for one agent over another; newer agents such as Miebo and Tyrvaya are not always covered. Manufacturer savings programs reduce copays for several of them, and we can help with authorizations and alternatives if a plan declines.