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Treating Dry Eye Disease: A Comprehensive Review of 5 FDA-Approved Medications

Dry eye disease (DED) is a common condition that affects millions of individuals worldwide. It is characterized by symptoms such as eye discomfort, dryness, redness, and visual disturbances. Fortunately, several FDA-approved medications are available to alleviate the signs and symptoms of DED and improve patients’ quality of life. In this article, we will provide an overview of 5 such medications: Eysuvis, Miebo, Restasis, and Tyrvaya and Xiidra.

Eysuvis (loteprednol etabonate ophthalmic suspension) 0.25% is a medication that utilizes mucus-penetrating particle (MPP) Drug Delivery Technology to enhance the penetration of loteprednol etabonate (LE) into the target tissue of the ocular surface. LE is a corticosteroid known for its anti-inflammatory properties. Eysuvis is specifically indicated for the short-term treatment of the signs and symptoms of dry eye disease. It is the quickest of the five to work. It is administered as a topical suspension, with one to two drops instilled into each eye four times daily for up to two weeks. The most common side effect reported during clinical trials was instillation site pain.

Miebo (perfluorohexyloctane ophthalmic solution) is a semifluorinated alkane designed to reduce tear evaporation at the ocular surface. It is supplied as a solution for topical administration and is indicated for the treatment of the signs and symptoms of dry eye disease. Patients are instructed to instill one drop of Miebo four times daily into the affected eye(s). It is important to remove contact lenses before administering Miebo and wait at least 30 minutes after application before reinserting them. Blurred vision and eye redness were reported as potential side effects.

Restasis (cyclosporine emulsion) 0.05% is a calcineurin inhibitor immunosuppressant that increases tear production in patients with keratoconjunctivitis sicca (dry eye disease) associated with ocular inflammation. It is supplied as an ophthalmic emulsion and is administered as one drop twice daily in each eye, approximately 12 hours apart. Restasis contains cyclosporine, which has anti-inflammatory effects and helps reduce inflammation of the lacrimal gland and ocular surface. Adverse effects associated with Restasis may include ocular burning, conjunctival hyperemia, and visual disturbance.

Tyrvaya (varenicline solution) nasal spray is a cholinergic agonist indicated for the treatment of the signs and symptoms of dry eye disease. It is supplied as a nasal spray and should be administered once in each nostril twice daily, approximately 12 hours apart. Tyrvaya’s mechanism of action is believed to involve varenicline’s activity at certain sub-types of the nicotinic acetylcholine receptor, which activates the trigeminal parasympathetic pathway, leading to increased production of the basal tear film. Side effects associated with Tyrvaya include sneezing, cough, throat irritation, and nasal instillation site irritation.

Xiidra (lifitegrast) is a leukocyte function-associated antigen-1 (LFA-1)/intracellular adhesion molecule-1 (ICAM-1) inhibitor. LFA-1 antagonists inhibit the migration and adhesion of white blood cells to sites of inflammation. Xiidra is specifically indicated for the treatment of the signs and symptoms of dry eye disease. It is administered as an ophthalmic solution, with one drop instilled twice daily in each eye, approximately 12 hours apart. Common side effects associated with Xiidra include instillation site irritation, dysgeusia (altered taste perception), and decreased visual acuity.

The FDA approvals of these medications were based on rigorous clinical trials. For instance, Eysuvis’ approval relied on four clinical trials involving approximately 2,900 patients with dry eye disease. Statistical significance was achieved for the treatment’s efficacy in reducing conjunctival hyperemia and ocular discomfort severity. Similarly, Miebo’s approval was based on two 57-day studies involving a total of 1,217 patients with dry eye disease. Significant improvements in tear production and eye dryness were observed in patients using Miebo. Restasis and Xiidra also demonstrated efficacy in clinical studies, leading to their FDA approvals.

It is important to consult with a healthcare professional before starting any medication for dry eye disease. They will evaluate your symptoms, medical history, and any potential contraindications to determine the most suitable treatment option for you. All the above medications require a prescription from a Doctor. At the Cohen Eye Institute we provide our patients with the latest in dry eye treatments. These could be via medications mentioned above or via procedures like Meibomian gland expression and punctual plugs or a combination of both.

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