Prescription dry eye drops compared: Restasis, Xiidra, Miebo and more

On this page

1. Why there’s no single best drop
2. At a glance
3. Cyclosporine: Restasis, Cequa, Vevye and generics
4. Lifitegrast: Xiidra
5. Perfluorohexyloctane: Miebo
6. Acoltremon: Tryptyr
7. Varenicline nasal spray: Tyrvaya
8. Short-course steroids: Eysuvis
9. Related treatments you may hear about
10. How your doctor may choose
11. Cost and insurance
12. Tips for using prescription drops
13. Common questions

Why there’s no single best drop

Dry eye isn’t one problem. In some people the eyes make too little of the watery part of tears, often because of inflammation. In many more, the oil glands along the eyelids are blocked, so tears evaporate too quickly (here’s more on the two main types). Prescription treatments go after different parts of that picture, so what your eye exam shows matters more than any ranking.

It’s also hard to compare them fairly. Each medicine was tested against an inactive drop, not against the others, and a 2024 review of the newer dry eye medicines couldn’t find a single trial comparing them directly11 Wong and Barak, Pharmacy, 2024 (opens in a new tab). Managing Dry Eye Disease with Novel Medications: Mechanism, Study Validity, Safety, Efficacy, and Practical Application.. Their studies also measured different things at different times: tear production after two weeks in one, eye dryness after three months in another. The labels themselves warn that side effect rates from one drug’s trials can’t be directly compared with another’s22 FDA prescribing information: Xiidra, via DailyMed (opens in a new tab). XIIDRA (lifitegrast ophthalmic solution) 5%..

So the numbers below tell you what each medicine did in its own studies, not which one is better. Several of the studies used the Schirmer test, where a small paper strip rests on the lower lid and measures how much tears wet it. A rise of at least 10 millimeters is the benchmark several of the FDA labels report.

At a glance

Cyclosporine: Restasis, Cequa, Vevye and generics

Good evidence Cyclosporine is the longest-standing prescription for dry eye. Restasis was first approved in 200233 US FDA, Drugs@FDA (opens in a new tab). Restasis (cyclosporine ophthalmic emulsion) 0.05%, NDA 050790, approved December 2002.. It’s thought to calm the immune activity on the eye’s surface that holds back tear production, although the labels note that the exact mechanism isn’t known44 FDA prescribing information: Cequa, via DailyMed (opens in a new tab). CEQUA (cyclosporine ophthalmic solution) 0.09%.. There are three versions, and they differ mainly in strength and in the liquid the medicine is carried in.

Restasis and generic cyclosporine 0.05%

A milky emulsion that comes in preservative-free single-use vials, or in the preservative-free Restasis MultiDose bottle55 FDA prescribing information: Restasis MultiDose, via DailyMed (opens in a new tab). RESTASIS MULTIDOSE (cyclosporine ophthalmic emulsion) 0.05%.. In its approval studies of about 1,200 people, roughly 15% reached that 10 millimeter rise in tear production after six months, compared with about 5% on the inactive drop. Burning was the most common side effect, in 17% of people. The label also notes that tear production didn’t increase in people who were already using anti-inflammatory eye drops or punctal plugs66 FDA prescribing information: Restasis, via DailyMed (opens in a new tab). RESTASIS (cyclosporine ophthalmic emulsion) 0.05%..

Generic cyclosporine 0.05% has been sold since the FDA approved the first generic version of Restasis in February 2022, and several companies now make it77 US FDA, Drugs@FDA (opens in a new tab). Cyclosporine ophthalmic emulsion 0.05%, Mylan (ANDA 205894), approved February 2022..

Cequa (cyclosporine 0.09%)

A clear solution in preservative-free single-use vials. In two studies of 1,048 people, about 17% reached the 10 millimeter rise after 12 weeks, compared with about 9% on the inactive drop. The most common side effects were pain when the drop goes in (22%) and eye redness (6%)⁴.

Vevye (cyclosporine 0.1%)

Here the cyclosporine is dissolved in a liquid with no water and no preservative, in a multi-dose bottle. The drops are small, and the label warns you may not feel one land. In two studies, about 10% reached the 10 millimeter rise after four weeks, compared with about 6% on the inactive drop. The most common side effects were reactions where the drop goes in (8%) and temporarily reduced sharpness of vision (3%)88 FDA prescribing information: Vevye, via DailyMed (opens in a new tab). VEVYE (cyclosporine ophthalmic solution) 0.1%..

Using cyclosporine: one drop in each eye twice a day, about 12 hours apart. Take contact lenses out first and wait 15 minutes before putting them back in. If you also use artificial tears, leave 15 minutes between the two⁶. Safety and effectiveness haven’t been established under age 16 for Restasis, or under 18 for Cequa and Vevye.

Lifitegrast: Xiidra

Good evidence Lifitegrast blocks a protein called LFA-1 that immune cells use to latch on and set off inflammation, although, as with cyclosporine, the exact way it helps dry eye isn’t known. It’s approved to treat both the signs and the symptoms of dry eye².

In four 12-week studies of 1,181 people, those using Xiidra reported less eye dryness than people on an inactive drop at both 6 and 12 weeks in all four studies. At 12 weeks, their eyes also showed less surface damage in three of the four².

The most common side effects, each reported by 5% to 25% of people, were irritation when the drop goes in, a change in taste and reduced sharpness of vision. It comes in single-use containers, one drop twice a day. Safety and effectiveness haven’t been established under age 17. Take contact lenses out first and wait 15 minutes before putting them back in².

Generic versions of lifitegrast have been approved, but as of September 2026 the FDA lists them as discontinued, so Xiidra remains the main option99 US FDA, Drugs@FDA (opens in a new tab). Lifitegrast ophthalmic solution 5%, generic approvals and marketing status..

Perfluorohexyloctane: Miebo

Strong evidence Miebo works differently from the rest. Its only ingredient is perfluorohexyloctane, with no water and no preservative. According to its label, it forms a thin layer on the surface of the tears that is expected to slow evaporation, though the exact way it helps dry eye isn’t known1010 FDA prescribing information: Miebo, via DailyMed (opens in a new tab). MIEBO (perfluorohexyloctane ophthalmic solution)..

It was studied in people with signs of meibomian gland dysfunction, the oil gland problem that’s the most common cause of dry eye1111 Lemp et al., Cornea, 2012 (opens in a new tab). Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort.. In two trials of 1,217 people, it reduced surface damage on the cornea and eye dryness compared with a saline drop, at both about two weeks and about eight weeks. Blurred vision was the most common side effect, in fewer than 4% of people¹⁰. A 2024 analysis that pooled these and two other randomized trials, about 1,800 people in all, found the results consistent from trial to trial. All of them lasted eight weeks or less, so there’s less evidence on long-term use1212 Guedes et al., Cureus, 2024 (opens in a new tab). Efficacy and Safety of Perfluorohexyloctane in Evaporative Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials..

You use one drop four times a day. Take contact lenses out first and wait at least 30 minutes before putting them back in, twice as long as for most of the other drops¹⁰. Safety and effectiveness haven’t been established under age 18.

Acoltremon: Tryptyr

Good evidence Tryptyr, approved in 20251313 US FDA, Drugs@FDA (opens in a new tab). Tryptyr (acoltremon ophthalmic solution) 0.003%, NDA 217370, approved May 2025., works on TRPM8, the sensor on the eye’s surface that detects cooling. Stimulating it is thought to trigger the nerve signals that lead to more natural tear production, although the exact mechanism in dry eye isn’t known1414 FDA prescribing information: Tryptyr, via DailyMed (opens in a new tab). TRYPTYR (acoltremon ophthalmic solution) 0.003%..

In two trials of 931 people, 43% and 53% of those using it reached the 10 millimeter rise in tear production after two weeks, compared with 8% and 14% on the inactive drop, and the results held at every visit through three months¹⁴.

Worth knowing: half of the people in the trials felt pain when the drop went in, although fewer than 1% stopped because of burning or stinging. It comes in single-dose vials, one drop twice a day. It can be used with other eye drops if you leave at least 5 minutes between them. Take contact lenses out first and wait 15 minutes before putting them back in. Safety and effectiveness haven’t been established in children¹⁴.

Varenicline nasal spray: Tyrvaya

Good evidence Tyrvaya is the only option here that doesn’t go in your eyes. It’s a nasal spray that’s thought to activate a nerve pathway inside the nose that leads to more natural tear production1515 FDA prescribing information: Tyrvaya, via DailyMed (opens in a new tab). TYRVAYA (varenicline solution) nasal spray..

In its two main trials, 52% and 47% of people using it reached the 10 millimeter rise in tear production after four weeks, compared with 14% and 28% on an inactive spray¹⁵.

Sneezing is very common, reported by 82% of people in the trials. Some also had a cough (16%), throat irritation (13%) or irritation inside the nose (8%). You use one spray in each nostril twice a day. Safety and effectiveness haven’t been established in children¹⁵. Because nothing goes in your eyes, some doctors consider it for people who wear contact lenses¹.

Short-course steroids: Eysuvis

Steroid drops calm inflammation quickly, which makes them useful for flare-ups, but they aren’t meant for long-term use. Eysuvis (loteprednol 0.25%) is approved for up to two weeks at a time, one to two drops four times a day. Your doctor should examine your eyes and check your eye pressure before renewing it. Longer use of steroid drops can raise eye pressure, which can lead to glaucoma, and can cause cataracts. Its most common side effect was pain when the drop goes in, in 5% of people1616 FDA prescribing information: Eysuvis, via DailyMed (opens in a new tab). EYSUVIS (loteprednol etabonate ophthalmic suspension) 0.25%..

Related treatments you may hear about

• Lotilaner (Xdemvy) isn’t a dry eye drug. It treats eyelid mites, which cause itchy, crusty lashes and symptoms that overlap with dry eye1717 US FDA, Drug Trials Snapshot: Xdemvy, 2023 (opens in a new tab). Drug Trials Snapshots: XDEMVY.. There’s more in our guide to Demodex blepharitis.
• Reproxalap has been in the news for years. The FDA declined to approve it for the third time in March 2026, so it isn’t available in the US1818 Fierce Biotech, March 2026 (opens in a new tab). FDA rejects Aldeyra dry eye disease drug for 3rd time, citing inconsistent study findings..
• In-office treatments such as intense pulsed light and thermal pulsation treat blocked oil glands directly. Our guide to dry eye treatments and their costs covers them.

How your doctor may choose

The choice depends on what your exam shows. These are the questions that usually come into it:

• What’s driving your dry eye? Inflammation and low tear production point one way, evaporation from blocked oil glands another. A 2024 review suggested cyclosporine when artificial tears aren’t enough, and perfluorohexyloctane for evaporative dry eye¹.
• Do you need quick relief or long-term control? A steroid course is for flare-ups. Cyclosporine and lifitegrast are twice-daily treatments for ongoing use.
• Do you wear contact lenses? Lenses come out for every drop here, for 15 or 30 minutes. The nasal spray avoids that.
• What does your insurance cover? Cost often decides between options that would all be reasonable.
• Which side effects can you live with? Burning, a change in taste and sneezing bother some people much more than others.

It’s common to use a prescription alongside artificial tears or in-office treatment. Whether combining two prescription medicines adds any benefit hasn’t been well studied¹. Several of these medicines were judged over weeks or months, so ask your doctor how long to give one before deciding whether it’s working.

Cost and insurance

Brand-name dry eye prescriptions can cost several hundred dollars a month without coverage. Generic cyclosporine usually costs much less. Insurance plans vary: many cover at least one option, but some ask you to try a lower-cost one first. Most brands run savings programs, which usually apply only to commercial insurance, not Medicare. Before you fill a prescription, ask your doctor’s office and your pharmacist what it will cost you, both with insurance and with any savings card.

Tips for using prescription drops

• Contact lenses. Take them out first. Most drops need a 15-minute wait before lenses go back in. Miebo needs at least 30 minutes.
• More than one drop. Leave a gap between different drops: 15 minutes for the cyclosporine drops, and at least 5 minutes for Tryptyr and Eysuvis.
• Single-use vials. Use each one straight after opening, then throw it away along with anything left in it.
• Keep it clean. Don’t let the tip of a vial or bottle touch your eye or anything else.
• Check your label. Some need a quick shake or a few turns before use, such as Eysuvis and Restasis MultiDose. Follow the instructions that come with yours.

Common questions

Sources

1. Managing Dry Eye Disease with Novel Medications: Mechanism, Study Validity, Safety, Efficacy, and Practical Application (opens in a new tab). Wong and Barak, Pharmacy, 2024.
2. XIIDRA (lifitegrast ophthalmic solution) 5% (opens in a new tab). FDA prescribing information: Xiidra, via DailyMed.
3. Restasis (cyclosporine ophthalmic emulsion) 0.05%, NDA 050790, approved December 2002 (opens in a new tab). US FDA, Drugs@FDA.
4. CEQUA (cyclosporine ophthalmic solution) 0.09% (opens in a new tab). FDA prescribing information: Cequa, via DailyMed.
5. RESTASIS MULTIDOSE (cyclosporine ophthalmic emulsion) 0.05% (opens in a new tab). FDA prescribing information: Restasis MultiDose, via DailyMed.
6. RESTASIS (cyclosporine ophthalmic emulsion) 0.05% (opens in a new tab). FDA prescribing information: Restasis, via DailyMed.
7. Cyclosporine ophthalmic emulsion 0.05%, Mylan (ANDA 205894), approved February 2022 (opens in a new tab). US FDA, Drugs@FDA.
8. VEVYE (cyclosporine ophthalmic solution) 0.1% (opens in a new tab). FDA prescribing information: Vevye, via DailyMed.
9. Lifitegrast ophthalmic solution 5%, generic approvals and marketing status (opens in a new tab). US FDA, Drugs@FDA.
10. MIEBO (perfluorohexyloctane ophthalmic solution) (opens in a new tab). FDA prescribing information: Miebo, via DailyMed.
11. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort (opens in a new tab). Lemp et al., Cornea, 2012.
12. Efficacy and Safety of Perfluorohexyloctane in Evaporative Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (opens in a new tab). Guedes et al., Cureus, 2024.
13. Tryptyr (acoltremon ophthalmic solution) 0.003%, NDA 217370, approved May 2025 (opens in a new tab). US FDA, Drugs@FDA.
14. TRYPTYR (acoltremon ophthalmic solution) 0.003% (opens in a new tab). FDA prescribing information: Tryptyr, via DailyMed.
15. TYRVAYA (varenicline solution) nasal spray (opens in a new tab). FDA prescribing information: Tyrvaya, via DailyMed.
16. EYSUVIS (loteprednol etabonate ophthalmic suspension) 0.25% (opens in a new tab). FDA prescribing information: Eysuvis, via DailyMed.
17. Drug Trials Snapshots: XDEMVY (opens in a new tab). US FDA, Drug Trials Snapshot: Xdemvy, 2023.
18. FDA rejects Aldeyra dry eye disease drug for 3rd time, citing inconsistent study findings (opens in a new tab). Fierce Biotech, March 2026.

Medicine details come from each product’s FDA prescribing information as of September 2026. Brand names are trademarks of their owners. Symvana has no financial relationship with any company that makes these medicines. This guide is for education and doesn’t replace advice from your eye doctor.