What Prescription is Used for Dry Eyes? A Comprehensive Pharmacology Guide

October 9, 2025 •

4 min read

Over 30 million Americans are estimated to suffer from chronic dry eye syndrome, a condition that can cause significant discomfort and impact vision. While over-the-counter artificial tears may provide temporary relief for mild cases, those with persistent or severe symptoms often require a doctor to determine what prescription is used for dry eyes to address the underlying causes.

Quick Summary

Prescription medications for dry eyes go beyond simple lubrication, targeting underlying issues like inflammation, insufficient tear production, and rapid tear evaporation. Options range from anti-inflammatory drops like cyclosporine and lifitegrast to innovative nasal sprays and treatments for meibomian gland dysfunction, offering targeted relief for chronic conditions.

Key Points

Restasis (Cyclosporine): An immunomodulatory eye drop that reduces inflammation to help your eyes produce more natural tears over time.
Xiidra (Lifitegrast): Another anti-inflammatory drop that works by blocking a protein interaction to reduce irritation and improve tear production.
Tyrvaya (Varenicline): A unique nasal spray that stimulates tear production via a nerve pathway in the nose, offering an alternative to eye drops.
Miebo (Perfluorohexyloctane): Specifically targets evaporative dry eye by forming a protective layer over the tear film to reduce tear evaporation.
Eysuvis (Loteprednol): A fast-acting, 'soft' corticosteroid prescribed for short-term use to quickly manage acute dry eye flare-ups.
Autologous Serum Drops: Custom-made from a patient's own blood for severe cases of dry eye that haven't responded to other treatments.
Lacrisert (Hydroxypropyl Cellulose): A daily insert that provides continuous, long-lasting lubrication.

Understanding the Need for Prescription Dry Eye Medications

Dry eye disease is a complex and often chronic condition caused by either a deficiency in aqueous (watery) tear production or excessive tear evaporation. For many patients, simple lubricating eye drops are not enough because they do not address the root causes of the disease, such as inflammation of the lacrimal gland or meibomian gland dysfunction. This is where prescription medications come into play, offering targeted pharmacological solutions.

The Role of Inflammation in Dry Eye

Ocular inflammation is a key factor in many chronic dry eye cases, often leading to a vicious cycle of irritation and reduced tear quality. Prescription medications that target and modulate this inflammatory response can help restore the eye's natural tear production and improve overall tear film stability.

Immunomodulatory Eye Drops

This class of medications is designed to suppress the immune response that contributes to ocular inflammation, providing a long-term treatment strategy for chronic dry eye.

Cyclosporine (Restasis, Cequa, Vevye)

Mechanism of Action: Cyclosporine is an immunosuppressant that inhibits T-cell activation, reducing inflammation and helping eyes produce more natural tears.
Administration: Typically one drop in each eye twice daily.
Onset of Action: Full effects may take 3 to 6 months; sometimes a short-term steroid is prescribed concurrently.
Formulations: Restasis and Cequa are cyclosporine drops; Cequa uses nanomicellar technology for better penetration. Vevye is a preservative-free formulation with a higher cyclosporine concentration.

Lifitegrast (Xiidra)

Mechanism of Action: Lifitegrast blocks the interaction of LFA-1 and ICAM-1, preventing T-cell activation and inflammation on the eye's surface.
Administration: One drop in each eye twice daily.
Onset of Action: Often quicker than cyclosporine, with improvement seen in a few weeks.
Formulation: Available in sterile, preservative-free single-use vials.

Corticosteroid Eye Drops

Corticosteroids offer rapid, short-term relief for acute dry eye flare-ups but are not for long-term use due to potential side effects.

Eysuvis (Loteprednol Etabonate): FDA-approved for dry eye flare-ups, this "soft steroid" is quickly metabolized, reducing long-term side effect risks.
Other Corticosteroids: Older formulations may be used with close monitoring.

Cholinergic Agonist Therapy

This approach stimulates tear production through a nerve pathway.

Tyrvaya (Varenicline Nasal Spray): Intranasal varenicline activates the trigeminal parasympathetic pathway, increasing basal tear film production. {Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}
Oral Cholinergic Agonists: Pilocarpine or cevimeline may be used, especially in conditions like Sjögren's syndrome, to stimulate tear and saliva production.

Treating Evaporative Dry Eye with Miebo

Miebo specifically addresses evaporative dry eye caused by meibomian gland dysfunction.

Miebo (Perfluorohexyloctane Ophthalmic Solution): This preservative-free, water-free drop forms a layer over the tear film to reduce evaporation and mimic healthy meibum.

Other Prescription Treatments and Considerations

Autologous Serum Eye Drops: Custom-made from a patient's own blood serum for severe, unresponsive dry eye cases, containing growth factors to promote healing.
Lacrisert (Hydroxypropyl Cellulose): A sterile, preservative-free insert that dissolves to provide continuous lubrication.
Combination Therapy: Eye doctors often combine treatments, such as a short-term corticosteroid followed by a long-term immunomodulator.

Comparing Key Prescription Dry Eye Medications


Feature	Cyclosporine (Restasis, Cequa)	Lifitegrast (Xiidra)	Varenicline (Tyrvaya)	Perfluorohexyloctane (Miebo)
Mechanism	Immunomodulator; inhibits T-cell activation to reduce inflammation and increase tear production.	Integrin antagonist; blocks LFA-1/ICAM-1 interaction to reduce inflammation and improve tear production.	Cholinergic agonist; {Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}	Evaporation inhibitor; {Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}
Indication	Aqueous-deficient dry eye associated with inflammation.	{Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}	{Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}	{Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}
Administration	Eye drops, typically twice daily.	Eye drops, typically twice daily.	Nasal spray, typically twice daily.	Eye drops, typically twice daily.
Onset of Action	Long-term; may take 3-6 months for full effect.	Faster onset; may see improvement in as little as 2 weeks.	Variable; can be faster-acting than immunomodulators.	Relatively fast; can provide rapid relief by stabilizing the tear film.
Common Side Effects	{Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}	{Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}	{Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}	{Link: Drugs.com https://www.drugs.com/medical-answers/what-best-eye-drops-dry-eyes-pharmacist-explains-3580023/}

Conclusion: Finding the Right Prescription for You

Choosing the right prescription medication for dry eyes is not a one-size-fits-all solution and depends on the specific cause and severity of the condition. A detailed evaluation by an eye care professional is crucial to determine whether your dry eye is aqueous-deficient, evaporative, or a combination of both. While immunomodulatory drops address underlying inflammation, other options target tear production via a nerve pathway or reduce evaporation to restore the tear film's stability. For acute flare-ups, short-term corticosteroids can provide rapid relief. Ultimately, a tailored treatment plan, possibly combining different therapies, is the most effective way to manage chronic dry eye and significantly improve quality of life.

For additional information and resources on dry eye, visit the American Academy of Ophthalmology: {Link: American Academy of Ophthalmology https://www.aao.org/eye-health/tips-prevention/new-dry-eye-treatments-ocular-surface-disease}.

Frequently Asked Questions

Yes, it is often common and safe to use both, but you should discuss the best regimen with your eye doctor. You should always instill the prescription drops first, waiting a few minutes before using any over-the-counter drops.

The onset of action varies by medication. Immunomodulators like Restasis and Cequa can take 3 to 6 months to become fully effective, while Xiidra may show results in as little as 2 weeks. Corticosteroids like Eysuvis work much faster for acute flare-ups.

Both are anti-inflammatory drops, but they have different mechanisms of action. Restasis (cyclosporine) is a calcineurin inhibitor, while Xiidra (lifitegrast) is an LFA-1 antagonist. Xiidra may have a faster onset of action.

Generic versions of cyclosporine, the active ingredient in Restasis and Cequa, are available. However, Xiidra (lifitegrast), Tyrvaya (varenicline), and Miebo (perfluorohexyloctane) currently do not have generic alternatives.

A nasal spray like Tyrvaya may be prescribed for patients with aqueous-deficient dry eye because it activates a nerve pathway in the nose to stimulate tear production, avoiding the stinging or burning that can sometimes occur with eye drops.

No, corticosteroids like Eysuvis are only intended for short-term use, typically for 1 to 2 weeks. Long-term use can increase the risk of side effects like elevated eye pressure (leading to glaucoma) and cataracts.

Both Cequa and Restasis contain cyclosporine. The key difference is the drug vehicle, as Cequa uses a nanomicellar technology designed to help the medication penetrate deeper into the ocular surface.

These drops are typically reserved for severe cases of dry eye where other treatments have been ineffective. They are custom-made from a patient's own blood serum and contain essential growth factors to promote healing.