Prescription Dry Eye Drops: Eysuvis, Tyrvaya, Tryptyr and More
Artificial tears add water. Prescription treatments change how the eye makes, keeps and calms its own tears. Here is what each one does, what the trials showed, and how we decide which one fits your dry eye.
Medically reviewed by Marc Shomer, MD, PhD
Why artificial tears are not enough
Artificial tears are the right first step, and for mild dry eye they may be enough. But if you use them more than four times a day and are still uncomfortable, the bottle is treating the symptom, not the disease. Chronic dry eye is an inflammatory cycle: an unstable tear film irritates the surface, the irritated surface releases inflammatory signals, the inflammation damages the tear glands, nerves and surface cells, and the damage makes the eye drier still. Water alone does not break that loop.
Prescription treatments do, in three different ways: by calming inflammation (Eysuvis, the cyclosporine and lifitegrast class), by switching on your own tear production through the nerves (Tyrvaya, Tryptyr), or by sealing the tear film against evaporation (Miebo). Which one helps depends on which of the three causes of dry eye you have: too few tears, tears that evaporate too fast because of meibomian gland dysfunction (MGD), or eyelids that cannot hold the tears. That is why every patient here starts with a comprehensive dry eye evaluation.
Eysuvis (loteprednol etabonate ophthalmic suspension 0.25 percent)
Eysuvis is a corticosteroid drop and the first steroid FDA-approved specifically for dry eye: short-term treatment, up to two weeks, of the signs and symptoms of dry eye disease. Two features separate it from older steroids. Loteprednol etabonate is a “soft” ester steroid: it acts on the surface of the eye and is then broken down by enzymes into an inactive form, so it raises eye pressure less often than prednisolone or dexamethasone. And it is carried in mucus-penetrating particles, nanoparticles coated so the tear film’s mucus layer does not trap them and more of the dose reaches the inflamed tissue.
How it is used
Shake the bottle, then place one to two drops in each eye four times daily for up to two weeks, then stop. It is a course, not a maintenance drop.
The clinical research
Eysuvis was studied in one phase 2 and three phase 3 trials, STRIDE 1, STRIDE 2 and STRIDE 3, which together enrolled 2,868 patients: 1,430 received Eysuvis and 1,438 received vehicle, the same drop without the steroid. The primary endpoints were conjunctival hyperemia (redness of the white of the eye) and ocular discomfort severity at day 15. Eysuvis reduced hyperemia significantly more than vehicle in each trial and reduced discomfort significantly more than vehicle in STRIDE 1 and STRIDE 3, with the manufacturer reporting measurable symptom improvement as early as day 4. In the pooled safety analysis (Korenfeld and colleagues, Cornea 2021), the most common side effect was pain on instillation, in 5.2 percent of Eysuvis patients and 4.4 percent on vehicle. A meaningful rise in intraocular pressure (more than 5 mmHg, to at least 21 mmHg) occurred in 0.6 percent of Eysuvis patients and 0.2 percent on vehicle. Patients with glaucoma were excluded.
Who is a candidate
Eysuvis is built for flares: the bad two weeks brought on by Santa Ana winds, a long flight, allergy season or the start of a slower-acting drop such as cyclosporine. It is also our tool for preparing the ocular surface before cataract surgery. The measurements that set your lens implant power are taken from the corneal surface, and a dry, irregular surface gives unreliable numbers; a short course beforehand improves their accuracy.
Steroid precautions
Every steroid drop, including a soft one, can raise intraocular pressure, slow healing and, over long periods, contribute to cataract. Eysuvis is not a long-term daily drop. We check your pressure if a course is repeated, and patients with glaucoma or a steroid pressure response use it only under the close monitoring our glaucoma specialist provides in the same building.
Tyrvaya (varenicline solution nasal spray 0.03 mg)
Tyrvaya is the first nasal spray approved for dry eye, and it works nowhere near the eye. Varenicline binds nicotinic acetylcholine receptors on nerve endings inside the nose and activates the trigeminal parasympathetic pathway, the reflex that makes your eyes water when you chop an onion. The result is more of your own natural tear film, all three layers, rather than a substitute dripped onto the surface. The dose is one spray in each nostril twice daily, about 12 hours apart.
In the pivotal trials, the primary endpoint was the share of patients whose Schirmer test, a measure of tear production, rose by 10 mm or more after four weeks. In ONSET-2, the phase 3 trial of 758 patients published in Ophthalmology in 2022, 47 percent of Tyrvaya patients reached that mark versus 28 percent on vehicle spray; in the smaller ONSET-1 trial, 52 percent versus 14 percent. The trade-off is the nose: sneezing in 82 percent of patients, almost always mild and over within a minute or two, then cough (16 percent), throat irritation (13 percent) and nose irritation (8 percent). Tyrvaya suits patients who cannot tolerate eye drops, who already use several drops for glaucoma or other conditions, and patients with low tear volume from Sjogren’s syndrome or after LASIK.
Tryptyr (acoltremon ophthalmic solution 0.003 percent)
Tryptyr was approved by the FDA on May 28, 2025 and is the first drug in a new class, the TRPM8 receptor agonists. TRPM8 is the cold-sensing receptor on the corneal nerves, the one that makes a cool breeze feel refreshing and that signals the lacrimal gland to keep the surface wet. Acoltremon stimulates those nerves, and the gland responds with more of your own tears. The dose is one drop in each eye twice daily, about 12 hours apart, from preservative-free single-use vials.
Two identical phase 3 trials, COMET-2 and COMET-3, randomized 931 patients to Tryptyr or vehicle for 90 days. The primary endpoint was a 10 mm or greater Schirmer increase at day 14. Tryptyr met it in both: 42.6 percent versus 8.2 percent with vehicle in COMET-2, and 53.2 percent versus 14.4 percent in COMET-3, roughly four times as many responders. Tear production was higher than vehicle from the first day through day 90. The most common side effect is burning or stinging as the drop goes in, reported by about half of patients (50.2 percent), almost always mild and brief; under 1 percent stopped because of it. Tryptyr suits aqueous-deficient dry eye when a patient prefers a drop to a nasal spray, or wants a preservative-free, fast-acting alternative to the immunomodulators below.
Cyclosporine and lifitegrast: Restasis, Cequa, Vevye and Xiidra
These are the immunomodulators, the drops most people mean by “prescription dry eye drops.” They do not add tears or stimulate nerves. They quiet immune activity on the ocular surface so the lacrimal gland, suppressed by inflammation, can recover and make more tears on its own. That takes time: expect three to six months of twice-daily use before the full effect, which is why we often bridge the wait with a short Eysuvis course.
Restasis (cyclosporine ophthalmic emulsion 0.05 percent) has been available since 2003. In its pivotal trials about 15 percent of patients gained 10 mm or more on the Schirmer test at six months versus about 5 percent on vehicle; 17 percent reported ocular burning. Cequa (cyclosporine 0.09 percent) carries a higher concentration in a nanomicellar solution; about 17 percent reached the same Schirmer gain at day 84 versus 9 percent on vehicle, with instillation site pain in 22 percent. Vevye (cyclosporine 0.1 percent) is dissolved in a water-free semifluorinated alkane instead of an oil emulsion, which many patients find less stinging; instillation site reactions occurred in 8 percent. Xiidra (lifitegrast ophthalmic solution 5 percent) blocks a different step, the LFA-1 protein that lets white blood cells attach to the surface, and tends to relieve symptoms somewhat sooner. Its most common side effects, each in 5 to 25 percent of patients, are irritation on instillation, an unusual taste (dysgeusia) as the drop drains into the nose, and briefly blurred vision. All four are dosed twice daily and are appropriate for long-term use.
These drops suit moderate to severe dry eye of any cause, Sjogren’s and other autoimmune dry eye, and anyone who needs a maintenance treatment for years. They pair naturally with punctal plugs or Lacrifill.
Miebo (perfluorohexyloctane ophthalmic solution)
Miebo is different from everything above: no water, no preservative and no active drug in the usual sense. It is 100 percent perfluorohexyloctane, a clear liquid that spreads over the tear film and slows evaporation, the job healthy meibomian gland oil should do. It is used as one drop four times daily; blurred vision and redness, the most common side effects, occurred in 1 to 3 percent of patients. Miebo is the prescription option for evaporative dry eye from meibomian gland dysfunction, and it works alongside LipiFlow and lid hygiene rather than replacing them.
How we choose
The prescription follows the cause. When the evaluation shows low tear volume (aqueous-deficient dry eye), the options are the tear stimulators, Tyrvaya or Tryptyr, and the cyclosporine or lifitegrast class, usually combined with punctal plugs or Lacrifill so the tears you gain are not drained away. When tears evaporate too fast, treatment is directed at the oil glands: LipiFlow, daily lid hygiene, and Miebo to seal the surface while the glands recover. A flare on top of either pattern, or a surface that must be quiet before cataract measurements, calls for a two-week course of Eysuvis. When collarettes at the lash base show Demodex mites driving the inflammation, the drop is Xdemvy. And when the eyelid cannot close or hold the tear film, no drop will do; that patient needs eyelid surgery. Most patients have more than one cause, so most plans combine two of these. Marc Shomer, MD, PhD reviews every plan against your evaluation measurements and repeats them to confirm the drop is working.
Insurance and samples
Coverage varies by plan and several of these drugs require prior authorization; our office handles those requests and can often start you on a sample while approval is pending.
Works Cited
- Eysuvis (loteprednol etabonate ophthalmic suspension) 0.25% prescribing information. DailyMed, U.S. National Library of Medicine.
- Korenfeld M, Nichols KK, Goldberg D, et al. Safety of KPI-121 ophthalmic suspension 0.25% in patients with dry eye disease: a pooled analysis of 4 multicenter, randomized, vehicle-controlled studies. Cornea. 2021;40(5):564-570. doi:10.1097/ICO.0000000000002452.
- Tyrvaya (varenicline solution) nasal spray prescribing information, 2024. U.S. Food and Drug Administration.
- Wirta D, Vollmer P, Paauw J, et al. Efficacy and safety of OC-01 (varenicline solution) nasal spray on signs and symptoms of dry eye disease: the ONSET-2 phase 3 randomized trial. Ophthalmology. 2022;129(4):379-387. doi:10.1016/j.ophtha.2021.11.004.
- Tryptyr (acoltremon ophthalmic solution) 0.003% prescribing information, 2025. U.S. Food and Drug Administration.
- Pattar GR, Wirta D, Jerkins G, et al. Acoltremon ophthalmic solution 0.003% for signs and symptoms of dry eye disease: results of phase 3 pivotal COMET-2 and COMET-3 studies. Ophthalmology. 2026;133(5):563-574. doi:10.1016/j.ophtha.2025.09.018.
- Alcon. Alcon announces FDA approval of Tryptyr (acoltremon ophthalmic solution) 0.003% for the treatment of the signs and symptoms of dry eye disease. Press release, May 28, 2025. investor.alcon.com.
- Prescribing information for Restasis, Cequa, Vevye, Xiidra and Miebo. DailyMed, U.S. National Library of Medicine.
Answers from our dry eye specialists.
Is Eysuvis a steroid?
Yes. Eysuvis is loteprednol etabonate 0.25 percent, a corticosteroid and the first steroid drop FDA-approved for dry eye. It is a soft ester steroid that breaks down into an inactive form after it acts, so it raised eye pressure in only 0.6 percent of trial patients versus 0.2 percent on vehicle. It is still a steroid, meant for two-week courses, not long-term daily use.
How long can I use Eysuvis?
Up to two weeks per course, one to two drops in each eye four times a day. If flares keep returning, the underlying cause needs a maintenance treatment such as a cyclosporine or lifitegrast drop, Tyrvaya, Tryptyr, plugs or LipiFlow, rather than repeated steroid courses.
Does Tyrvaya really work?
In the ONSET-2 phase 3 trial, 47 percent of patients using Tyrvaya twice daily gained 10 mm or more on the Schirmer tear production test at four weeks, versus 28 percent with a vehicle spray; in ONSET-1 the figures were 52 versus 14 percent. The main side effect is brief sneezing, reported by about 82 percent of patients.
What is Tryptyr?
Tryptyr is acoltremon 0.003 percent, a preservative-free drop approved in May 2025 and the first TRPM8 receptor agonist. It stimulates the cold-sensing corneal nerves that signal the tear gland to make more tears. In COMET-2 and COMET-3, 42.6 and 53.2 percent of patients gained 10 mm or more of tear production at day 14 versus 8.2 and 14.4 percent on vehicle. About half feel brief burning or stinging when the drop goes in.
Restasis or Xiidra, which is better?
Neither is better for everyone. Both are used twice daily and calm inflammation so the eye makes more tears. Restasis (cyclosporine 0.05 percent) works slowly over three to six months and causes burning in about 17 percent of patients. Xiidra (lifitegrast 5 percent) often relieves symptoms sooner but causes an unusual taste and instillation irritation in 5 to 25 percent. We choose based on your findings, your tolerance and your insurance formulary.
Can I use these drops with punctal plugs?
Yes, and the combination is common. Plugs or Lacrifill keep tears, and any prescription drop, on the eye longer. For low tear production we often pair plugs with a cyclosporine or lifitegrast drop, Tyrvaya or Tryptyr. Eysuvis can also be used with plugs in place; because it stays on the eye longer, we watch eye pressure a little more closely.
Find the Right Prescription for Your Dry Eye
The board-certified ophthalmologists at Eye MDs of Inland prescribe Eysuvis, Tyrvaya, Tryptyr, cyclosporine and lifitegrast drops and Miebo in Upland, matched to the cause found at your evaluation. Serving Rancho Cucamonga, Ontario, Claremont, Montclair, Chino, Pomona, Fontana, San Bernardino and Riverside.