Is there a prescription medication for dry eye syndrome?

Prescription Medications for Dry Eye Syndrome

Yes, there are FDA-approved prescription medications for dry eye syndrome, with the primary options being cyclosporine ophthalmic emulsion 0.05% and lifitegrast ophthalmic solution 5%, which target the underlying inflammation in moderate to severe cases. 1, 2, 3

Treatment Algorithm for Dry Eye Disease

Step 1: Mild Dry Eye

• Environmental modifications (humidifying ambient air, avoiding air drafts, practicing conscious blinking)
• Preserved artificial tears (≤4 times/day)
• Address underlying conditions (blepharitis, meibomian gland dysfunction)

Step 2: Moderate Dry Eye

When mild treatments are insufficient, add:

1. Prescription Anti-inflammatory Medications:

   • Cyclosporine ophthalmic emulsion 0.05% (Restasis) 1

     • Mechanism: Inhibits T-cell activation and inflammatory cytokine production
     • Dosing: Twice daily
     • Efficacy: 72-74% success rate in moderate dry eye
     • Note: May cause ocular burning in 17% of patients

   • Lifitegrast ophthalmic solution 5% (Xiidra) 1, 3

     • Mechanism: Blocks interaction between LFA-1 and ICAM-1
     • Approved by FDA in 2016 for both signs and symptoms of dry eye
     • Shows benefit in corneal/conjunctival staining and symptom reduction
     • Clinical trials showed significant improvement in Eye Dryness Score

2. Preservative-free artificial tears (if using >4 times/day)

3. Consider punctal plugs to retain tears

Step 3: Severe Dry Eye

Add to previous treatments:

• Short-term topical corticosteroids (2-4 weeks)
• Autologous serum eye drops
• Scleral lenses
• Amniotic membrane grafts

Important Clinical Considerations

• Patient Education: Critical for treatment success, especially when initiating cyclosporine, as 97.1% of successful second trials included physician education 4

• Inflammation Management: 40-65% of symptomatic dry eye patients have significant inflammation requiring targeted treatment 2

• Corticosteroid Use: Can decrease ocular irritation symptoms and improve filamentary keratitis, but should be limited to short periods (several weeks) with monitoring for increased intraocular pressure and cataract formation 1

• Contact Lens Considerations: Remove lenses before administering lifitegrast and wait 15 minutes before reinserting 3

• Treatment Duration: Cyclosporine may be a disease-modifying agent requiring long-term therapy, with some patients able to decrease to once daily after a full year of twice-daily therapy 1

Cautions and Monitoring

• Monitor for increased intraocular pressure and cataract formation with corticosteroid use
• Burning/stinging is the most common reason for discontinuation of cyclosporine (60% of cases) 4
• Lifitegrast safety has been established for 12 months, but long-term effects remain unknown 1
• Avoid prolonged use of preserved artificial tears (>4 times/day) as they can cause toxicity 2

Both cyclosporine and lifitegrast have demonstrated efficacy in clinical trials, with improvements in both objective measures (corneal staining, Schirmer test) and subjective symptoms (dryness, discomfort). The combination of punctal plugs with cyclosporine may provide additive benefits for some patients 5.