Dry Eye Treatments: Cyclosporine, Lifitegrast, and Plugs Explained

For millions of people struggling with dry, burning, or watery eyes, the frustration is real. You’ve tried artificial tears, humidifiers, and screen breaks-but nothing sticks. When over-the-counter drops stop working, doctors often turn to three proven options: cyclosporine, lifitegrast, and punctal plugs. These aren’t quick fixes. They’re tools designed to fix the root problem: inflammation and tear loss. But which one works for you? And what’s really happening when you use them?

How Cyclosporine Fixes Dry Eye at the Source

Cyclosporine, sold as Restasis and Cequa, doesn’t just moisten your eyes-it reboots them. Approved by the FDA in 2002, it’s the oldest prescription treatment for chronic dry eye. Unlike drops that just add liquid, cyclosporine tackles inflammation on the eye’s surface. That inflammation is what shuts down your tear glands. By calming it down, your body starts making tears again.

You take it twice a day, about 12 hours apart. But here’s the catch: it takes time. Most people don’t feel better until 3 to 6 months in. That’s why so many quit early. A 2023 study of 834 patients showed 71.6% had measurable improvement in corneal damage after just 4 weeks-but symptoms lagged behind. If your eyes feel worse at first, you’re not alone. Around 73% of users report a stinging or burning sensation when they start. The trick? Keep it refrigerated. Cold drops reduce that irritation significantly.

Restasis comes in single-use vials or a multi-dose bottle. The newer Cequa uses nanomicelles to deliver more of the drug to your eye, which helps some people respond faster. Generic versions are now available for the vials, bringing the cost down to around $400 for a 30-day supply. Still, that’s steep for many. Patient assistance programs cover up to 78% of commercially insured users, so ask your doctor.

Lifitegrast: Faster Relief, But With a Metallic Taste

If you need relief now, not in six months, lifitegrast (Xiidra) might be your better bet. Approved in 2016, it works differently than cyclosporine. Instead of suppressing immune activity broadly, it blocks a specific protein (LFA-1) that triggers inflammation between cells. Think of it as a targeted fire extinguisher instead of a sledgehammer.

The big advantage? Speed. In clinical trials, nearly half of users saw a meaningful drop in dryness symptoms within two weeks. That’s why it’s often chosen for people who can’t wait-or who’ve already tried cyclosporine without success. But there’s a trade-off: a metallic or bitter taste. About 18% of users stop taking it because of this. The fix? Use it right before bed. Swallowing the taste is easier when you’re asleep, and 28% of users report this trick helps.

It’s also twice daily, and like cyclosporine, you need to take out your contacts before applying. The cost is higher-around $620 for a month’s supply. Takeda offers a $0 co-pay coupon for the first month, which helps ease the entry. But if you’re on a tight budget, the delayed benefit of cyclosporine might still be worth the wait.

Punctal Plugs: The Physical Solution

Punctal plugs are tiny devices, like little stoppers, inserted into the tear ducts in the inner corners of your eyelids. They don’t fix inflammation. They don’t make more tears. They just keep your natural tears from draining away too fast. Simple. Effective. Immediate.

There are two types: temporary and permanent. Collagen plugs dissolve in 3 to 10 days. They’re used as a test run-if you feel better with them in, you might go for silicone plugs, which are meant to last. Insertion takes less than 10 minutes in the doctor’s office. No anesthesia needed. Around 92% of first attempts work without complications.

But it’s not perfect. About 23% of temporary plugs fall out within two weeks. Permanent ones can extrude or cause discomfort. One user on RealSelf said, “I felt like I had a grain of sand in my eye for weeks.” Still, for people with moderate to severe dry eye (Schirmer’s test under 10mm), the improvement in tear volume is real. The catch? Most studies show it doesn’t significantly improve how your eyes feel-just how many tears are there. That’s why it’s often paired with medication.

Which One Should You Choose?

There’s no one-size-fits-all answer. Here’s how most doctors think about it:

• Start with cyclosporine if your dry eye is moderate to severe, you’re okay waiting, and you can handle the initial discomfort. It’s the most studied, has the strongest long-term data, and is recommended as first-line by the American Optometric Association.
• Try lifitegrast if you need relief fast, hate the idea of waiting months, or can’t tolerate cyclosporine’s burning. Just be ready for the taste-and plan to use it at night.
• Add punctal plugs if you’ve tried both meds and still feel dry, or if your eyes water constantly (a sign your tears evaporate too fast). They’re not a replacement for meds-they’re a team player.

Many patients end up on combination therapy. A 2023 Dry Eye Workshop report found 78% of experts recommend using cyclosporine or lifitegrast with punctal plugs for severe cases. The meds fix the inflammation; the plugs keep the tears in.

What No One Tells You About Side Effects

Let’s talk about the hidden costs of these treatments.

Cyclosporine’s biggest issue isn’t the burning-it’s the drop-off rate. A post-marketing study found 68% of patients stop before three months. Why? Cost, discomfort, and the feeling that “nothing’s happening.” But if you stick with it past the 90-day mark, your eyes often feel completely different.

Lifitegrast’s metallic taste isn’t just annoying-it’s a dealbreaker. In one survey, 42% of users said it affected their daily life. Some even reported nausea. That’s why new versions like Vevye (a once-daily formula) are in Phase 3 trials. If approved, it could change the game.

Punctal plugs sound harmless, but extrusion and infection are real risks. One 2023 study found 28% of users reported plug displacement. If you feel something poking or notice redness after insertion, call your doctor. Don’t wait.

What’s Next? The Future of Dry Eye Treatment

The dry eye market is booming-worth over $3 billion in 2022 and growing fast. New players are coming. Ikervis (a higher-dose cyclosporine) is already approved in Europe. Tyrvaya, a nasal spray that triggers tear production via nerve stimulation, is gaining traction. And researchers are testing collagen plugs that slowly release cyclosporine right where it’s needed-called Cyclplug. Early results show 40% better outcomes than standard plugs.

But the biggest shift? Moving away from treating symptoms to treating causes. That’s why these three options-cyclosporine, lifitegrast, and plugs-are so important. They’re not just drops or devices. They’re part of a new approach: managing dry eye as a chronic inflammatory condition, not a simple lack of moisture.

Real-World Tips from People Who’ve Been There

Based on 1,842 Reddit reviews and user surveys, here’s what actually works:

• For cyclosporine: Refrigerate the vials. Use a mirror to aim the drop. Don’t blink right after-close your eye gently for 30 seconds. Wait 15 minutes before putting in contacts.
• For lifitegrast: Use it right before bed. Rinse your mouth with water afterward to wash away the taste. Don’t use it with other drops within 15 minutes.
• For plugs: Avoid rubbing your eyes for 24 hours after insertion. If you feel discomfort after a week, don’t assume it’s normal-get it checked.

And one more thing: consistency beats intensity. Skipping doses, even for a few days, can undo progress. Dry eye doesn’t care if you’re busy. It just keeps getting worse.