Dry eye disease treatment landscape: What's new, what's gone, and what's next

The dry eye disease (DED) space has been shaped by decades of evolving understanding of inflammation's central role — from the days of simple artificial tears to the 2003 approval of Restasis (cyclosporine 0.05%), which fundamentally changed how eye care providers think about and treat DED. Anti-inflammatory therapies — including steroids, immunomodulators, thermal expressive therapy, and light therapy — now form the backbone of DED management, targeting everything from T-lymphocyte recruitment to meibomian gland dysfunction driven by Demodex mites and bacterial inflammation.

The 2026 update brings a mix of progress and setbacks. Tarsus released encouraging phase 4 data (RHEA and ERSA studies) showing Xdemvy improves signs and symptoms of evaporative DED, while Bausch + Lomb's Miebo claimed the top spot as the most prescribed branded dry eye medication. On the downside, AzaSite remains unavailable due to ongoing manufacturing issues, and AbbVie is pulling traditional sales support for Restasis, moving management in-house.

Key Takeaways:

• Two new generic cyclosporine 0.05% formulations (Saptalis and Upsher-Smith) have received U.S. approval, joining the existing Viatris version — but vehicle formulation differences may affect clinical efficacy
• Bausch + Lomb reported positive phase 2 results for a dual-action Xiidra/Miebo combination drop, showing improvements in both corneal staining and patient-reported symptoms at just 15 days
• Harrow has acquired Flarex and clinicians are encouraged to reintegrate it into their treatment rotation

Why it matters: With Restasis losing commercial momentum and AzaSite off the market, clinicians managing DED need to stay current on emerging alternatives and generic formulation differences that could impact patient outcomes.