Understanding Miebo and its Purpose
Miebo (perfluorohexyloctane) is a prescription ophthalmic solution approved for treating the signs and symptoms of Dry Eye Disease (DED) [1.4.1]. It is the first and only FDA-approved treatment that directly targets tear evaporation [1.3.5]. Unlike many other eye drops that are water-based, Miebo is composed of 100% perfluorohexyloctane, a semifluorinated alkane [1.3.6]. This unique, water-free composition allows it to form a monolayer at the air-liquid interface of the tear film, which is thought to reduce the rate of tear evaporation, a primary cause of DED for many patients [1.5.6]. This mechanism helps stabilize the tear film, protecting the eye's surface and alleviating common symptoms like dryness, itching, and a gritty sensation [1.5.1].
Deciphering the Bottle's Duration: Dosage and Drop Size
When prescribed Miebo, a common question arises: How long does one bottle of Miebo last? According to the manufacturer, Bausch + Lomb, a single 3 mL bottle of Miebo is intended to provide a full 30-day supply [1.2.1]. The standard recommended dosage is one drop instilled into each affected eye, four times per day [1.4.3].
A key factor that causes confusion is the drop size. Traditional, water-based eye drops have a drop size of 30 to 50 microliters, leading to a standard estimation of 15-20 drops per mL [1.2.1]. However, Miebo's drop is significantly smaller, at only 11 microliters [1.3.2]. Because of this smaller, more concentrated drop, a 3 mL bottle contains approximately 270 drops [1.2.4].
Let's do the math:
- Daily Usage: 1 drop/eye x 2 eyes x 4 times/day = 8 drops per day.
- Monthly Usage: 8 drops/day x 30 days = 240 drops.
- Total Drops per Bottle: ~270 drops [1.2.2].
This calculation shows that the ~270 drops in the bottle are sufficient for the required 240 drops over a 30-day period. However, many users report running out of the medication before the month is over [1.7.2, 1.7.3]. This discrepancy is often due to the unique properties of the drop and the specific administration technique required.
Proper Administration is Key
Because the Miebo drop is small and water-free, patients may not feel the drop upon application, leading them to dispense extra drops accidentally and deplete their supply prematurely [1.2.5]. To ensure a single drop is dispensed each time, the manufacturer provides a specific priming and administration process [1.2.4]:
- Prime the Bottle: Before the first use, and for every subsequent use, hold the bottle upright and squeeze it. While still squeezing, turn the bottle completely upside down.
- Release Pressure: Once upside down, release the pressure. This action primes the dropper to release just one drop.
- Instill the Drop: Position the bottle above your eye and gently squeeze again to release a single drop [1.2.3].
Following these steps carefully is crucial to prevent wastage and ensure the bottle lasts the intended 30 days. Contact lenses should be removed before administration and can be reinserted after 30 minutes [1.4.1].
Comparison with Other Dry Eye Medications
Miebo enters a market with other established prescription treatments for DED, such as Restasis (cyclosporine) and Xiidra (lifitegrast). Here is a comparison:
| Feature | Miebo (perfluorohexyloctane) | Restasis (cyclosporine) | Xiidra (lifitegrast) |
|---|---|---|---|
| Mechanism | Forms a protective layer to prevent tear evaporation [1.5.6] | Helps increase the eyes' natural ability to produce tears [1.6.2] | A lymphocyte function-associated antigen-1 (LFA-1) antagonist that reduces inflammation [1.6.5] |
| Administration | One drop, 4 times daily [1.4.3] | One drop, 2 times daily | One drop, 2 times daily |
| Formulation | 3 mL multi-dose bottle, preservative-free [1.2.1, 1.3.5] | Single-use vials or multi-dose bottle, preservative-free [1.6.2] | Single-use vials |
| Primary Side Effect | Blurred vision (1-3% of patients) [1.5.7] | Burning sensation in the eye | Eye irritation, unusual taste sensation (dysgeusia) [1.6.5] |
| Approx. Cash Price | ~$783 for one 3 mL bottle [1.6.7] | ~$97 (generic) for a 30-day supply [1.6.2] | ~$617 for 60 single-use doses [1.6.7] |
Conclusion
A 3 mL bottle of Miebo is manufactured to last for 30 days when used as prescribed—one drop in each eye, four times daily [1.2.1]. The bottle's unique design and the medication's small, waterless drop size necessitate a specific administration technique to prevent accidental overuse [1.2.5]. While many patients have found significant relief from DED symptoms with Miebo [1.7.1], a common concern is the bottle not lasting the full month, which highlights the importance of mastering the proper application process. If you have trouble with the administration or find your supply depleting too quickly, consult your eye care professional for guidance.
For more information from the manufacturer, visit https://www.miebo.com/how-to-use/.
