Prescription and Advanced Care / Immunomodulators
Comparing Restasis, Cequa, Vevye, and Xiidra
These four are the most talked-about prescription drops for chronic dry eye. They all work on inflammation, but they differ in their active ingredient, how they are delivered, and how they are FDA-approved. This guide compares them in plain language so you can have a better conversation with your eye doctor. Dry Eye Rescue does not sell or prescribe any of them. There is no single best one. The right choice depends on you.
Key Takeaways
- Restasis, Cequa, Vevye, and Xiidra are all prescription eye drops used for chronic dry eye, and all work by calming inflammation on the surface of the eye.
- Restasis, Cequa, and Vevye are all forms of cyclosporine, at different concentrations and in different delivery vehicles. Xiidra (lifitegrast) works through a different anti-inflammatory pathway.
- They are taken as ongoing therapy, usually one drop in each eye twice a day, and the cyclosporine drops often take several weeks to reach their full effect.
- There is no single best option. They have not been directly compared in a way that names one as better, and people respond and tolerate them differently.
- All four require a prescription and an exam. Dry Eye Rescue does not sell or prescribe them. Use the Doctor Locator to find an eye care professional who can.
Quick Answer: How do these four compare?
All four are prescription anti-inflammatory drops for chronic dry eye, taken twice a day. Restasis (cyclosporine 0.05%), Cequa (cyclosporine 0.09%), and Vevye (cyclosporine 0.1%) are different versions of cyclosporine, a calcineurin inhibitor, in different strengths and vehicles. Xiidra (lifitegrast 5%) targets a different inflammatory pathway. Their FDA-approved wording differs slightly too: Restasis and Cequa are approved to increase tear production, while Vevye and Xiidra are approved for the signs and symptoms of dry eye disease. Which one fits is an individual decision made with your eye doctor.
What These Drops Have in Common
Chronic dry eye often involves ongoing inflammation on the surface of the eye, which can keep the eyes from making and keeping healthy tears. All four of these prescriptions work on that inflammation rather than simply adding moisture, which is why they are used as steady, daily therapy rather than as a quick fix. Each is taken as one drop in each eye twice a day, contact lenses are removed before use, and each is something an eye doctor prescribes and monitors over time.
The two cyclosporine drops Restasis and Cequa are FDA-approved to increase tear production in dry eye, while Vevye and Xiidra are approved for the signs and symptoms of dry eye disease, and all four are taken as one drop in each eye twice daily. Source: U.S. FDA prescribing information for RESTASIS, CEQUA, VEVYE, and XIIDRA.
Side-by-Side Comparison
| Drop | Active ingredient | How it works | FDA-approved use | Dosing |
|---|---|---|---|---|
| Restasis | Cyclosporine 0.05% (emulsion) | Calcineurin inhibitor that calms ocular surface inflammation | Increase tear production in dry eye (keratoconjunctivitis sicca) | One drop each eye twice daily |
| Cequa | Cyclosporine 0.09% (nanomicellar) | Higher-concentration cyclosporine with a delivery technology for absorption | Increase tear production in dry eye (keratoconjunctivitis sicca) | One drop each eye twice daily |
| Vevye | Cyclosporine 0.1% (water-free) | Cyclosporine in a water-free, preservative-free vehicle | Signs and symptoms of dry eye disease | One drop each eye twice daily |
| Xiidra | Lifitegrast 5% | LFA-1 antagonist that works on a different inflammatory pathway | Signs and symptoms of dry eye disease | One drop each eye twice daily |
Restasis, Cequa, and Vevye are all forms of cyclosporine, a calcineurin inhibitor, while Xiidra (lifitegrast) works through a different anti-inflammatory pathway involving a protein called LFA-1. Source: U.S. FDA prescribing information.
Restasis (Cyclosporine 0.05%)
Restasis is the longest-established of the group and uses cyclosporine in an emulsion. It is FDA-approved to increase tear production in people whose tears are reduced because of inflammation linked to dry eye. It is taken twice a day, and a generic version of cyclosporine 0.05% is now also available, which can matter for cost and access. Like the other cyclosporine drops, it usually takes several weeks of regular use before the full benefit shows.
Cequa (Cyclosporine 0.09%)
Cequa offers the highest FDA-approved concentration of cyclosporine and is delivered with a nanomicellar technology designed to help the medication penetrate the surface of the eye. It is preservative-free and is FDA-approved to increase tear production in dry eye, taken twice a day. It is one option a doctor may consider, including for people looking for a higher-strength cyclosporine.
Vevye (Cyclosporine 0.1%)
Vevye is a newer cyclosporine drop, approved in 2023. What makes it different is its water-free, preservative-free vehicle, which carries cyclosporine without the water, oils, or surfactants found in some other drops. It is FDA-approved for the signs and symptoms of dry eye disease and is taken twice a day. Some people find a water-free formulation comfortable, which is a point to discuss with your eye doctor.
Xiidra (Lifitegrast 5%)
Xiidra is the one that is not cyclosporine. Its active ingredient, lifitegrast, blocks a different step in the inflammatory process by acting on a protein called LFA-1. It is FDA-approved for the signs and symptoms of dry eye disease and is taken twice a day. A well-known quirk is that some people notice a temporary unusual taste shortly after using it. Because it works differently from the cyclosporine drops, it is sometimes considered when one approach has not been the right fit.
There are no studies that directly compare Xiidra with the cyclosporine drops, so none can be called better than another. The right choice depends on the individual. Source: manufacturer prescribing information for XIIDRA.
How a Doctor Chooses Between Them
There is no ranking that fits everyone. An eye doctor weighs what is driving your dry eye, how your eyes have responded to past treatments, how well you tolerate a given drop, and practical factors like insurance coverage and cost. It is common to try one, give it enough time, and switch if it is not the right fit. Many people also keep using supportive products, like preservative-free artificial tears, alongside a prescription. The goal is a plan that works for your eyes, not a single best-selling name.
Cyclosporine drops typically take several weeks of regular use before their full effect is seen, which is why they are used as ongoing therapy rather than for instant relief. Source: U.S. FDA prescribing information and manufacturer data.
Supportive Products Alongside a Prescription
Prescription drops work on inflammation over time, so many people use over-the-counter products for everyday comfort while they wait for the prescription to take effect. Your eye doctor can tell you which of these fit your routine.
Preservative-Free Drops
Gentle, preservative-free lubrication for frequent daytime comfort.
Compare the Options
See how popular preservative-free drops differ to find a good daily fit.
Overnight Dryness
Thicker gels and ointments help protect the eyes through the night.
Dry Eye Rescue Tip
Give a prescription drop time. The cyclosporine options in particular can take several weeks before you notice the full benefit, so stopping early can make a helpful drop seem like it failed. Keep supportive artificial tears handy for comfort in the meantime, and tell your eye doctor about any stinging, taste changes, or other effects so they can adjust the plan rather than you switching on your own.
Find a Dry Eye Specialist Near You
These are prescription drops, so they start with an exam. Dry Eye Rescue works with a network of over 5,000 eye care professionals. Use the Doctor Locator to find a specialist near you, or take the DryEye Q assessment to prepare for your visit.
Important Disclaimer
This page is educational and does not replace medical advice from your eye care professional or healthcare provider. It does not recommend any specific prescription medication. Dry Eye Rescue does not sell, dispense, or prescribe any prescription treatment. Decisions about starting, stopping, or changing any medication should be made only with a licensed eye doctor after an examination. Descriptions reflect FDA-approved labeling at the time of writing and may change; always refer to the current prescribing information and your doctor's guidance. RESTASIS, CEQUA, VEVYE, XIIDRA, and other brand names referenced are trademarks of their respective owners.
Frequently Asked Questions
What do Restasis, Xiidra, Cequa, and Vevye have in common?
They are all prescription eye drops for chronic dry eye that work by calming inflammation on the surface of the eye, and all are taken as one drop in each eye twice a day as ongoing therapy.
How are they different?
Restasis, Cequa, and Vevye are all cyclosporine at different concentrations and in different vehicles, while Xiidra is lifitegrast and works on a different pathway. Their approved wording also differs slightly, with some approved to increase tear production and others for the signs and symptoms of dry eye.
Which one is best?
There is not a single best option for everyone. They differ in active ingredient, concentration, delivery, and approval, and people respond and tolerate them differently. The right choice is one your eye doctor makes with you based on your eyes, your response, and practical factors like cost and coverage.
Are Restasis, Cequa, and Vevye all cyclosporine?
Yes. All three use cyclosporine, a calcineurin inhibitor, but at different strengths (0.05%, 0.09%, and 0.1%) and in different delivery vehicles, including an emulsion, a nanomicellar solution, and a water-free formulation.
How long until they work?
The cyclosporine drops in particular often take several weeks of regular use before the full effect is noticeable, which is why they are used as steady daily therapy. Your doctor can tell you what to expect and when to follow up.
Can I use artificial tears with them?
Often yes. Many people use preservative-free artificial tears for comfort while a prescription takes effect. Timing can matter, so ask your eye doctor how to space your drops.
Do I need a prescription for these?
Yes. All four require a prescription and an eye exam. Dry Eye Rescue does not sell or prescribe them. We can help you find a doctor in our network who can decide what fits.
Is there a generic version?
There is now a generic of cyclosporine 0.05%, the same strength as Restasis, which can affect cost and access. Cequa, Vevye, and Xiidra are currently brand-name only. Your doctor or pharmacist can explain the options for your situation.
How do I find a doctor to discuss these?
Use the Dry Eye Rescue Doctor Locator to find an eye care professional near you from our network of over 5,000 providers. Taking the DryEye Q assessment first can help you prepare for the visit.
Talk to a Doctor About Your Options
These prescriptions start with an exam. Find an eye care professional near you, prepare with the DryEye Q, or see all prescription options.
