While the majority of dry eye cases are caused by Meibomian Gland Dysfunction, where your oil-producing glands in the eyelids produce poor-quality oils, the majority of prescriptions for dry eye are meant to treat Aqueous Deficient Dry Eye, which occurs when your lacrimal glands fail to make tears.
When it comes to prescriptions, there are two main categories of drugs that will be utelized to treat dry eye: Steroids and Cyclosporine. We will go into further detail below about how Steroids as well as Cyclosporine can help dry eye, as well as touch on some other medication options that are available as well.
Steroids are used to treat dry eye because they can rapidly reduce inflammation, which is a cause of and contributing factor to dry eye. Steroids have the advantage of being fast-acting, so they are a good treatment for providing noticable dry eye relief quickly. However, steroids cannot be used long term due to side effects that can occur with prolonged use, including glaucoma, cataracts as well as an increased risk of fungal infections of the eye. Steroids are typically only used for short term bursts of treatment, between 7 and 30 days.
If your doctor prescribes steriods for longer than 10 days, they may want you to visit them again in that time frame so they can check your intraocular pressure (IOP). Steroids can rapidly raise your IOP which can lead to glaucoma. Fortunately there are steroids that have a good safety profile, such as Loteprednol Etabonate. This steroid can be found under the brand names of Alrex and Lotemax. Alrex contains less steroids per drop than Lotemax. Other steroids can also be used safely as well if used for short periods of time under a doctor's supervision.
The other class of drug used for dry eye disease is Cyclosporine and can be found under the brand names Restasis and Cequa. This drug is an immunosuppressant so it helps to calm the immune system in the eye down to reduce inflammation. Unfortunately it can take a long time to work, upwards of a few months. Some doctors may start you on a steroid and then move you to a Cyclosporine based drug for longer term dry eye management.
Cyclosporine is safe to use for long term use and does not have the same safety concerns as steroid based treatments.
The brand name Restasis is the original Cyclosporine drop and has been on the market for a while now. Cequa is a newer drop, which contains more Cyclosporine than Restasis and also contains a new delivery mechansim to help with absorption of the drug.
Unfortunately many insurance companies refuse to pay for either Restais or Cequa or make you jump through hoops to get the drug approved. One option may be to check with the manufacturer, as they often have a discount card or other way to save available. However these options also often expire after the first year on the drops.
Luckily, you can also get Cyclosporine drops from a compounding pharmacy or as a compounded drop called Klarity-C. You can get Klarity-C drops for $59 per month, which is paid out of pocket directly and bypasses your insurance company. This option for many may be cheaper than the co-pay for either Restasis or Cequa.
Xiidra is another drop that helps to increase tear production. It works by stopping a protein that can cause inflammation and lack of tear production. It may be a good option for you, especially if other steroid or cyclosporine drops are not effective for you. Like with Cyclosporine drops, you may have problems getting insurance to cover this medication and unlike Cyclosporine drops, there is no generic version available.
One of the side effects of dry eye is that a lot of mucus is produced, which can interfere with vision and be uncomfortable. Acetylcysteine (Mucomyst) drops are great at breaking up mucus in your eye. These drops must be purchased from a compounding pharmacy which will make them special for you. They must be refigerated and will last for about 30 - 45 days once opened.
These drops are typically not covered by insurance. A typical cost for these drops is around $65 USD for a 30 day supply, with an additional $15 to ship them to you inside of a refigerated cooler.
If you have tried everything else, Autologous Serum Drops may be something that offers you some relief. These are drops that are made from your own blood, which contains a lot of the same vitamins and proteins as your natural tears. More information on these drops can be found here.
To get these drops made, you will have to have your blood drawn. Then the blood will need to be transported to a compounding pharmacy that will make the drops special for you out ouf your blood. This treatment is not cheap, with a batch of drops costing between $200 and $400. This does not include the blood draw, which your health insurance may or may not cover, depending on your plan.
There are many promising drugs on the horizon for dry eye treament. One drug, Lacripep, claims to treat the cause of dry eye rather than only treating inflammation. There's also another drop that claims it will treat Meibomian Gland Dysfunction. For more information on what is coming down the pipeline, visit our section on expermental treatments and clinical trials.