What eye drops are comparable to Xiidra? An overview of dry eye treatments

October 8, 2025 •

4 min read

Chronic dry eye disease affects millions of people, but Xiidra isn't the only solution available. When exploring what eye drops are comparable to Xiidra, it's crucial to understand that alternatives vary in their mechanism of action, onset of relief, and active ingredients.

Quick Summary

Several prescription eye drops, including Restasis and Cequa, are comparable to Xiidra for chronic dry eye by addressing inflammation. Other options, like steroids or nasal sprays, offer different approaches, while over-the-counter artificial tears provide temporary lubrication.

Key Points

Prescription Alternatives: Restasis and Cequa are prescription eye drops that, like Xiidra, target underlying inflammation in chronic dry eye using the active ingredient cyclosporine.
Different Mechanisms: While Xiidra is an LFA-1 antagonist, Restasis and Cequa are calcineurin inhibitors, addressing inflammation via different pathways.
Onset of Action: Xiidra can provide symptom relief in as little as two weeks, but Restasis and Cequa may take several months to reach full effectiveness.
Other Prescription Options: Steroid drops like Eysuvis are for short-term dry eye flare-ups, while Tyrvaya is a nasal spray that stimulates tear production.
Over-the-Counter Lubricants: For mild dry eye or supplementary treatment, OTC artificial tears from brands like Systane and Refresh provide temporary relief without addressing the root cause.
Specialized Treatments: For severe or unresponsive dry eye, autologous serum eye drops, made from the patient's own blood, may be a suitable option.
Cost Considerations: Restasis has a generic version available, which can make it a more cost-effective long-term treatment compared to the brand-name-only Xiidra and Cequa.

Understanding Xiidra and its mechanism

Xiidra (lifitegrast) is a prescription eye drop approved by the FDA for the treatment of dry eye disease. Unlike temporary lubricating drops, Xiidra targets inflammation, a key underlying cause of chronic dry eye. Its active ingredient, lifitegrast, works by blocking the interaction between two proteins, LFA-1 and ICAM-1. This process reduces the inflammation and T-cell activation that can damage the ocular surface and disrupt natural tear production. Patients using Xiidra typically notice symptom improvement within a few weeks, though full effects can take longer.

Prescription eye drop alternatives to Xiidra

For those seeking alternatives to Xiidra due to side effects, cost, or a lack of effectiveness, several other prescription treatments are available. The most common alternatives work in different ways to address the root causes of dry eye.

Cyclosporine eye drops: Restasis and Cequa Restasis (cyclosporine ophthalmic emulsion 0.05%) and Cequa (cyclosporine ophthalmic solution 0.09%) are two leading alternatives that also address inflammation. They both contain cyclosporine, a calcineurin inhibitor that acts as an immunosuppressant to help increase natural tear production.

Restasis: An older formulation that has been used successfully for nearly two decades. It is available as a brand-name medication in single-use vials and a generic version, which can make it a more affordable long-term option. The full effect can take up to six months to be realized.
Cequa: A newer formulation with a higher concentration of cyclosporine (0.09%). Cequa utilizes nanomicellar technology to enhance the penetration of cyclosporine into the ocular tissues, which some studies suggest may provide a faster onset of action than Restasis, though it is not a faster option than Xiidra.

Corticosteroid eye drops: Eysuvis For short-term treatment of dry eye disease flare-ups, a doctor may prescribe a steroid eye drop like Eysuvis (loteprednol etabonate ophthalmic suspension 0.25%).

Eysuvis: Acts as an anti-inflammatory to quickly calm severe inflammation. Due to the risk of side effects with prolonged use, such as increased intraocular pressure and cataracts, Eysuvis is typically only used for up to two weeks at a time.

Neurostimulatory nasal spray: Tyrvaya Tyrvaya (varenicline nasal spray) offers a completely different approach for those who dislike eye drops.

Tyrvaya: This nasal spray works by activating a nerve in the nose that triggers the production of natural tears. It is approved for chronic dry eye and has been shown to improve symptoms for many patients.

Autologous serum tears In severe cases of dry eye that don't respond to conventional therapy, autologous serum tears may be used.

Mechanism: These specialized eye drops are prepared from the patient's own blood serum and contain essential growth factors and nutrients similar to natural tears. They are typically preservative-free and can help restore the ocular surface.

Over-the-counter (OTC) alternatives

For milder dry eye symptoms or as a supplement to prescription treatment, OTC eye drops are often the first line of defense.

Artificial Tears: These drops lubricate the eye's surface and come in various formulations, including drops with different viscosities (gels and ointments), or those with or without preservatives. Popular brands include Systane and Refresh.
Lipid-Based Drops: For dry eye caused by evaporative issues (Meibomian Gland Dysfunction), lipid-based artificial tears can help stabilize the oily layer of the tear film to reduce evaporation.
Preservative-Free Drops: Many patients with sensitive eyes or those who use drops frequently benefit from preservative-free artificial tears to minimize irritation.

Comparison of Xiidra and its primary alternatives


Feature	Xiidra (lifitegrast 5%)	Restasis (cyclosporine 0.05%)	Cequa (cyclosporine 0.09%)	Eysuvis (loteprednol 0.25%)
Mechanism of Action	LFA-1 antagonist; reduces inflammation via T-cell pathway	Calcineurin inhibitor; reduces inflammation via immunosuppression	Calcineurin inhibitor; reduces inflammation via immunosuppression with enhanced delivery	Corticosteroid; blocks inflammatory mediators for quick relief
Onset of Action	As early as 2 weeks for some, with full effect in 6-12 weeks	Several weeks to months, with full effect taking up to 6 months	Possibly faster than Restasis due to enhanced absorption, but still a longer-term treatment	Rapid, with effect typically seen within days
Typical Duration	Long-term treatment for chronic dry eye	Long-term treatment for chronic dry eye	Long-term treatment for chronic dry eye	Short-term treatment (up to 2 weeks) for flare-ups
Generic Availability	No generic currently available	Yes (cyclosporine ophthalmic emulsion)	No generic currently available	No generic currently available
Common Side Effects	Eye irritation, unusual taste, blurred vision	Burning sensation, stinging, redness, blurred vision	Instillation site pain, eye irritation, redness, headaches	Instillation site pain, potential for increased eye pressure with long-term use

Choosing the right treatment

While numerous options are available, the best choice depends on the specific cause and severity of your dry eye disease, as well as your personal health profile and preference. For example, if you have moderate inflammation, Xiidra or a cyclosporine-based drop like Restasis or Cequa may be appropriate long-term solutions, while Eysuvis could be used for an acute flare-up. Cost and insurance coverage are also major considerations, especially since Restasis has an affordable generic option.

Ultimately, a detailed discussion with an eye care professional is essential to determine the most suitable treatment plan. Only a doctor can accurately diagnose the underlying issue and recommend the best course of action, which may involve a single medication, a combination of drops, or even other treatments like punctal plugs. For more information on the mechanism of action for Xiidra, you can review the FDA prescribing information.

Conclusion

For those asking "what eye drops are comparable to Xiidra?", the answer depends on your specific dry eye needs. Prescription options like Restasis, Cequa, Eysuvis, and Tyrvaya each offer distinct approaches to treating the inflammatory nature of chronic dry eye, while OTC artificial tears provide lubrication for more mild symptoms. Choosing the right path requires understanding these options and consulting with a healthcare professional to identify the most effective and tolerable solution for long-term relief.

Frequently Asked Questions

The effectiveness of Restasis versus Xiidra can vary from person to person. Clinical studies have shown both to be effective at treating chronic dry eye, but they work through different mechanisms. Some patients may respond better to one than the other, and a doctor's recommendation is the best guide.

Cequa and Xiidra differ primarily in their active ingredients and mechanism of action. Cequa contains cyclosporine, a calcineurin inhibitor, while Xiidra contains lifitegrast, an LFA-1 antagonist. Both work to reduce inflammation, but they target different parts of the inflammatory process.

No, it is not recommended to use Xiidra and Restasis together. You should discuss with your eye doctor before switching between these medications to ensure a proper transition.

No, there are no over-the-counter alternatives that work in the same way as Xiidra. While OTC artificial tears can provide temporary relief by lubricating the eyes, they do not address the underlying inflammation in the same way as prescription anti-inflammatory drops.

The onset of action varies by medication. Xiidra can start showing relief in as little as a couple of weeks, though maximum effect may take 6-12 weeks. Restasis and Cequa can take several months for patients to notice significant improvements.

Tyrvaya is a prescription nasal spray that treats chronic dry eye. It works by stimulating natural tear production through a nerve pathway in the nose, offering an alternative for patients who prefer not to use eye drops.

Autologous serum eye drops are used for severe dry eye cases that do not respond to conventional treatments. Made from a patient's own blood serum, they contain essential growth factors and nutrients that can help restore the health of the ocular surface.