Oral medications can play a role in reducing inflammation and improving the oil quality in the meibomian glands in Meibomian Gland Dysfunction. Doxycycline, Azithromycin and minocycline have been shown to be effective for treating evaporative dry eye.

Short courses of steroid eye drops can be beneficial in improving the signs and symptoms of dry eye disease due to the underlying inflammatory processes. EYsuVIS® (loteprednol etabonate) is a steriod specifically approved for Dry Eye Disease in some countries. They form part of an overall treatment approach & cannot be used longterm due to risks of side effects.

Autologous serum eye drops are blood-derived eye drops - they contain growth factors, fibronectin, immunoglobulins & vitamins in a similar or higher concentration to natural tears. They are used for severe dry eye with corneal damage, to promote re-epithelialization & healing of the ocular surface. The cost and inconvenient process of obtaining them is a barrier to their more widespread use.

The anti-inflammatory Cyclosporine ophthalmic emulsion 0.05% (Restasis®, Allergan) received FDA approval in 2003 for the treatment of dry eye disease. It is helpful to improve the signs and symptoms, but it is not available in all parts of the world. Cequa™ is another commercially available option in the US, Canada and Australia. In Australia and Asia, Ikervis®, is also able to be prescribed for severe dry eye. Some pharmacies may be able to formulate a similar preparation at the request of an ophthalmologist.

Cequa (cyclosporine 0.09%, Sun Ophthalmics) was approced by the FDA in 2018. It increases tear production and reduced inflammation associated with dry eye. Cequa is unique due to its nanomicellar delivery system. Used twice a day, Cequa is avaliable in the US, Australia and is being approved in New Zealand.

Lifitegrast (Xiidra®) is a medication that treats the signs & symptoms of dry eye by reducing inflammation. Twice daily application of lifitegrast ophthalmic solution 5.0% has been shown to improve moderate to severe dry eye. Lifitegrast (Xiidra®) is available in the US and Australia.

Tyrvaya (varenicline tartrate solution 0.03mg, Viatris) is a nasal spray approved by the FDA in October 2021 to treat the signs and symptoms of DED. It is applied to the inside the nose twice a day to stimulate tear production via neuro-activation. While it can make you sneeze and cough, it’s been found to be well tolerated and it can also help in aqueous deficient dry eye. Tyrvaya is currently available in the USA, and not in Australia or New Zealand.

Eysuvis (loteprednol etabonate ophthalmic suspension 0.25%, Alcon) is a corticosteroid eye drop used for the treatment of flare up of symptoms and inflammation in Dry Eye. In 2020, it became the first topical steroid to be approved by the FDA for the short-term treatment of dry eye. In one of its clinical trials, Eysuvis was found to be significantly effective for treatment of hyperemia and dry eye without elevating intraocular pressure (IOP). Eysuvis is available in Canada and the USA.