Treating Dry Eye Disease: A Look at Today’s Medications

Dry eye disease affects millions of patients, yet the growing list of treatment options can make decision-making feel more complicated than ever. Treating dry eyes requires understanding not just what options are available, but where each one fits into therapy.

In this episode, TRC Healthcare Assistant Editor and Clinical Pharmacist Gina Corley, PharmD, walks through the causes of dry eye disease and breaks down today’s treatment landscape, from OTC artificial tears to prescription options like cyclosporine, lifitegrast, and newer therapies. She highlights how these medications work, where they fit in therapy, and practical counseling tips to help patients get relief.

This is an excerpt from our November 2025 Pharmacy Essential Updates continuing education webinar series.

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CE Information:

TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.

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Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights: 

• Article: Have Treatment Options in Sight for Dry Eye Disease
• Chart: Treatments for Dry Eyes
• Technician Tutorial: The Ins and Outs of Eye and Ear Meds

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Transcript

This transcript is automatically generated. 

00:00:04 Narrator

Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.

00:00:10 Narrator

On this episode, Assistant Editor and Clinical Pharmacist Gina Corley breaks down dry eye disease, what causes it, and some of the available treatment options. 

00:00:20 Narrator

She discusses everything from artificial tears to newer prescription drugs and where they fit into practice in an excerpt from our popular Pharmacy Essential Updates webinar series.  

00:00:30 Narrator

This podcast offers Continuing Education credit for pharmacists and pharmacy technicians. Please log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.

00:00:43 Narrator

None of the speakers have anything to disclose. 

00:00:46 Narrator

Catch new episodes of Clinical Capsules every 2nd and 4th Tuesday—bringing concise, actionable insights from TRC experts straight to your ears.

00:00:55 Narrator

Let’s take a closer look…

00:01:03 Gina Corley

Now let's dive into a review of all the different meds that patients can use for dry eye disease.

00:01:10 Gina Corley

And from our article, there are a plethora of different meds to choose from.

00:01:16 Gina Corley

So today we're going to go over some of our options and see where they fit in therapy.

00:01:22 Gina Corley

But first, let's talk a little bit about the background of dry eye disease.

00:01:28 Gina Corley

So dry eye disease occurs when tears can't adequately lubricate the eyes, which can lead to inflammation and surface damage.

00:01:37 Gina Corley

Patients can experience burning, stinging, irritation, or have a sensation of a foreign body such as sand or grit in the eye.

00:01:48 Gina Corley

Some risk factors include age over 50, female gender, having low vitamin A, or wearing contact lenses.

00:01:57 Gina Corley

Now let's go over some things that can cause dry eye disease.

00:02:02 Gina Corley

Our tears are made up of fatty oils, aqueous fluid, and mucus.

00:02:07 Gina Corley

And there are numerous things that can disrupt this tear film and lead to increased dryness.

00:02:13 Gina Corley

Some examples include hormone changes, autoimmune diseases, inflammation, and allergies.

00:02:21 Gina Corley

Dry eye disease can also be caused by decreased tear production or increased tear evaporation, which is important to know since some drugs target these mechanisms.

00:02:35 Gina Corley

We'll expand more on decreased tear production and increased tear evaporation in a little more detail.

00:02:42 Gina Corley

But first, let's talk about normal tear production.

00:02:47 Gina Corley

In normal tear production, your eyes have tear glands or lacrimal glands that continuously produce tear fluid.

00:02:56 Gina Corley

This fluid moisturizes the surface of your eyes every time you blink and drains out of your eyes and into your nose through tear ducts in the inner corners.

00:03:07 Gina Corley

However, some people don't produce enough tears.

00:03:11 Gina Corley

This can be caused by aging or certain medications,

along with certain diseases, such as allergic eye disease or thyroid disorders, or even nerve damage in the eye.

00:03:26 Gina Corley

Other people can experience increased tear evaporation.

00:03:30 Gina Corley

This happens when the small glands on the edge of your eyelids, called meibomian glands, become clogged.

00:03:38 Gina Corley

Common causes of this include meibomian gland dysfunction, blinking less often, eye allergies, or being exposed to wind, smoke, or dry air.

00:03:51 Gina Corley

So now, before we get into meds to treat dry eye disease, let's talk about common meds that can contribute to dry eyes.

00:04:01 Gina Corley

These include ACE inhibitors such as lisinopril, antihistamines such as loratadine,

and beta-blockers such as propranolol.

00:04:10 Gina Corley

If patients are on any of these meds, you can encourage them to reach out to their prescriber to talk about adjusting the dose or suggest some of the OTC or prescription eye drop options that I'll talk about next.

00:04:24 Gina Corley

So when it comes to meds that treat dry eye disease, there are plenty of options to choose from.

00:04:30 Gina Corley

We'll dig into each of them in much more depth, but for now, I just want to mention them at a high level to kind of orient ourselves.

00:04:40 Gina Corley

So first, we have OTC lubricants and artificial tears, such as Refresh Tears or Systane.

00:04:49 Gina Corley

And these work by providing lubrication and moisture to the eye.

00:04:54 Gina Corley

Next, we have our cyclosporine meds, Restasis, Cequa, and Vevye,

which help to decrease inflammation and increase natural tear production.

00:05:05 Gina Corley

We also have lifitegrast, or Xiidra, which may also help decrease inflammation by inhibiting LFA-1, a surface protein found on certain white blood cells.

00:05:18 Gina Corley

Next, we have perfluorohexyloctane, or Miebo, which helps to stabilize tears and reduce tear evaporation.

00:05:28 Gina Corley

Then we have acoltremon, or Tryptyr, which works by activating a receptor called TRPM8, leading to increased natural tear production.

00:05:39 Gina Corley

And lastly, we have varenicline, or Tyrvaya.

00:05:43 Gina Corley

You may be more familiar with varenicline as an oral medication used to quit smoking.

00:05:49 Gina Corley

But varenicline also comes as a nasal spray that's used to help treat dry eyes by increasing tear production.

00:05:57 Gina Corley

Okay, so now that we've got our bearings here with these drug classes, let's explore each of them and talk about some considerations or nuances with each.

00:06:07 Gina Corley

So let's start first with the OTC lubricants, such as Refresh Tears and Systane.

00:06:13 Gina Corley

They're usually tried first line, especially for mild to moderate cases of dry eye, but can also be combined with the other therapies that I'll talk about for added relief.

00:06:24 Gina Corley

Patients should start by using these two to four times per day, but can increase to every 30 to 60 minutes if needed.

00:06:32 Gina Corley

If patients complain of more severe symptoms, we can point them to gels or ointments, since the thicker consistency can provide longer-lasting lubrication.

00:06:43 Gina Corley

But caution that this can also lead to temporary blurred vision.

00:06:47 Gina Corley

Similarly, we can suggest preservative-free formulations, such as Refresh Plus, if patients complain of eye irritation, although some of these formulations may be more costly.

00:06:59 Gina Corley

And then some oral supplements are marketed for dry eye as well.

00:07:03 Gina Corley

These multi-ingredient supplements contain things like omega-3s, omega-6s, vitamin D, or lutein, and they claim to work due to their anti-inflammatory or antioxidant effects.

00:07:16 Gina Corley

Common brands include Blink NutriTears and PreserVision.

00:07:20 Gina Corley

If patients ask about these, you can say that they may be worth a try, but point out evidence is limited.

00:07:27 Gina Corley

So if OTCs aren't enough, the next med we usually try is ophthalmic cyclosporine.

00:07:33 Gina Corley

It's dosed twice a day and comes in three different brands, each with different strengths.

00:07:38 Gina Corley

So we have Restasis 0.05%, Cequa 0.09%, and Vevye 0.1%.

00:07:45 Gina Corley

Keep in mind, none of these strengths are interchangeable with each other, and there haven't been good studies that show one is better than another.

00:07:55 Gina Corley

In terms of price, these meds cost about $600 to $800 per month for cash-paying patients, although the Restasis brand comes in a generic, which costs around $200 per month.

00:08:08 Gina Corley

Keep in mind, some insurance companies may have a preferred brand of cyclosporine, so you may see some prior auths, but most insurances will likely cover the generic.

00:08:19 Gina Corley

So when it comes to cyclosporine, there are a few things we want to make sure patients know.

00:08:24 Gina Corley

For starters, patients may experience burning, blurred vision, or redness when inserting drops, but these effects are mild and usually only temporary.

00:08:34 Gina Corley

And then if patients are using other eye drops, we want to advise them to wait to use cyclosporine at least 15 minutes before or after applying other drops.

00:08:45 Gina Corley

For instance, sometimes a steroid eye drop, such as loteprednol 0.25%, is added on to cyclosporine to help with symptom relief,

since cyclosporine drops can take up to six weeks to start working.

00:08:59 Gina Corley

So in this case, we'd want to separate the cyclosporine and the loteprednol by at least 15 minutes.

00:09:06 Gina Corley

Next, we'll talk about lifitegrast or Xiidra.

00:09:10 Gina Corley

This can also be considered a second-line agent if OTCs aren't enough and tends to help in patients with reduced tear production caused by inflammation.

00:09:21 Gina Corley

It's also dosed twice daily like cyclosporine, but takes much less time to kick in, about two weeks.

00:09:27 Gina Corley

But it costs around $720 per month, and there's no generic available.

00:09:35 Gina Corley

And then while lifitegrast has side effects such as irritation and blurred vision that are typical of most eye drops, it can also cause taste disturbances, which is a unique side effect.

00:09:46 Gina Corley

So if patients complain of this, we want to instruct them to gently apply pressure to the inner corners of the eyes after administering the drops, which will help to decrease the drainage of the drops into the nose and throat.

00:10:00 Gina Corley

If this does not work, patients can try switching to a different drop if needed.

00:10:06 Gina Corley

Our next drug is perfluorohexyloctane, or Miebo.

00:10:11 Gina Corley

And as the brand name suggests, this one is often tried in patients with meibomian gland dysfunction, which is a condition where oil-secreting glands in your eyelids don't produce enough oil to prevent your eyes from drying out.

00:10:25 Gina Corley

Like most eye drops, it can cause blurred vision and eye irritation and redness.

00:10:31 Gina Corley

In general, lean towards trying other options first.

00:10:35 Gina Corley

Perfluorohexyloctane costs around $800 per month and is dosed four times a day, which is more inconvenient.

00:10:44 Gina Corley

Plus, patients who wear contact lenses will need to wait 30 minutes before placing their contacts back in, unlike 15 minutes with most other eye drops.

00:10:55 Gina Corley

Next, we have acoltremon, or Tryptyr, which is the first drug in a new class for dry eye disease and is dosed twice per day.

00:11:04 Gina Corley

This med targets the TRPM8 receptor and claims to stimulate tear production as early as day one.

00:11:12 Gina Corley

But for now, we want to reserve this as a last line option.

00:11:17 Gina Corley

Acoltremon costs around $900 per month, and there's no evidence that it works better than other meds.

00:11:26 Gina Corley

Plus, almost 50% of patients reported burning or stinging upon application.

00:11:33 Gina Corley

Last, I wanted to touch on varenicline or Tyrvaya, which comes as a nasal spray for dry eyes.

00:11:39 Gina Corley

It works by activating a nerve pathway in the nose to stimulate the body's natural tear production.

00:11:46 Gina Corley

This is different than oral varenicline for smoking cessation, which works on nicotinic pathways in the brain.

00:11:54 Gina Corley

And as you probably guessed, the two different forms of varenicline are not interchangeable.

00:12:00 Gina Corley

For now, save varenicline nasal spray for patients who can't tolerate eye drops.

00:12:05 Gina Corley

It's dosed twice per day but costs almost $700 per month.

00:12:09 Gina Corley

And there's no comparative studies with other eye meds.

00:12:12 Gina Corley

Also, we want to keep a close eye on prescriptions since Tyrvaya sounds a lot like Tryptyr that I just mentioned.

00:12:20 Gina Corley

So to summarize, we want to choose meds for dry eye disease based on patient and payer preference, along with symptoms and disease severity.

00:12:31 Gina Corley

And then there are also some non-drug strategies that you can point out to patients to help manage dry eyes.

00:12:38 Gina Corley

Things like limiting screen time with computers or smartphones, avoiding dry or dusty environments, drinking plenty of water, quitting smoking, avoiding alcohol, and using a humidifier can all help cut down on dry eye symptoms.

00:12:55 Gina Corley

Finally, I wanted to go over a few tips on eye drop administration.

00:13:00 Gina Corley

We want to tell patients to tilt their head back, pull down on the lower eyelid to form a pocket, and look up before instilling the drop.

00:13:11 Gina Corley

If that's difficult, the patient could also lie down, place a drop in the inner corner of the closed eyelid, and then open the eye slowly to allow the drop to roll in.

00:13:25 Gina Corley

To minimize systemic absorption, advise patients to close the eyes after instilling a drop and gently press on the inside corner of the eye for about 1–2 minutes.

00:13:37 Gina Corley

Lastly, tell patients to avoid touching the tip of the dropper to the eye since this can lead to eye infections.

00:13:47 Gina Corley

To help keep all the dry eye meds along with their dosing and costs straight, see our Treatments for Dry Eyes chart on our website.

00:14:00 Narrator

Thanks for listening—we hope today’s episode gave you practical insights you can use right away.

00:14:05 Narrator

Now that you’ve listened, pharmacists and pharmacy technicians can receive CE credit. Just log into your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.

00:14:17 Narrator

We’ve linked the resources we mentioned—and more on today’s topic—right in the show notes. Those links will take you straight to our websites, where you’ll find even more concise, evidence-based charts, articles, and tools.

00:14:29 Narrator

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00:14:45 Narrator

Have a question or a topic suggestion? Reach out using the ‘send us a text’ link in the show notes or email ContactUs@TRChealthcare.com. Your perspective matters—share your thoughts anytime to help shape future episodes.

00:15:00 Narrator

Thanks for listening… stay sharp, stay current—and join us next time on Clinical Capsules!