Dry Eye Syndrome Drug Summary

Last updated: 22 May 2025

Eye Corticosteroids*


Drug Available Strength Dosage Remarks
Betamethasone 0.1% ophthalmic drops

Adjusted based on the severity of symptoms. Should be tapered appropriately.



 
 

Adverse Reactions

  • Ocular effects (conjunctival hyperemia, conjunctivitis, corneal ulcers, delayed wound healing, glaucoma, increased intraocular pressure [IOP], keratitis, loss of accommodation, optic nerve damage, mydriasis, posterior subcapsular cataract formation, ptosis, secondary ocular infection)
Special Instructions
  • Avoid use in patients with viral diseases of the cornea and conjunctiva (eg acute superficial herpes simplex keratitis), mycobacterial or fungal infections of the eye
  • Monitor IOP of patients receiving treatment for ≥10 days
  • Withdraw therapy with gradual dose tapering

 
 
 
Dexamethasone 0.5 mg/1 mL ophthalmic drops;
0.1% ophthalmic gel; 0.1% ophthalmic suspension/drops/ointment
Fluorometholone 0.02% ophthalmic suspension;
0.1% ophthalmic suspension/drops
Loteprednol etabonate 0.2% ophthalmic suspension;
5 mg/1 mL ophthalmic solution
Prednisolone
 0.5% ophthalmic drops;
1% ophthalmic drops 
Rimexolone
 1% ophthalmic drops
*Combination with various antibiotics are available. Please see the latest MIMS for specific formulations.

Ophthalmic Anti-Inflammatories


Drug Available Strength Dosage Remarks
Ciclosporin (Cyclosporine) 0.05% ophthalmic solution;
0.1% ophthalmic emulsion

Instill 1 drop 12 hourly in each eye

Adverse Reactions

  • Ocular effects (ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, photophobia, foreign body sensation, visual disturbance)
Special Instructions
  • Avoid use in patients with ocular infection or known hypersensitivity to any components
  • Avoid eyedropper tip to come in contact with the eyes
  • Avoid use while wearing contact lenses
    • Lenses may be reinserted after 15 minutes
  • May give concomitantly with artificial tears with 15-minutes interval
Lifitegrast 5% ophthalmic solution

Instill 1 drop 12 hourly in each eye

Adverse Reactions

  • GI effect (dysgeusia); Ocular effects (blurred vision, conjunctival hyperemia, irritation, discharge, pruritus, increased lacrimation); Other effects: (headache, sinusitis)
Special Instructions
  • Avoid use while wearing contact lenses
    • Lenses may be reinserted after 15 minutes
  • Avoid the eyedropper tip to come in contact with the eyes

Ophthalmic Lubricants*


Drug Available Strength Dosage Remarks
Carbomer
(Polyacrylic acid)
 0.3% ophthalmic gel

Instill 1 drop 8-12 hourly as needed

Adverse Reactions

  • Temporary visual disturbances, allergic reactions
Special Instructions
  • Use with caution when driving or operating machines
  • Avoid use while wearing contact lenses

 
2 mg/g ophthalmic gel Instill 1 drop into the conjunctival sac 3-5x/day and 30 minutes prior to bedtime 
0.25% ophthalmic gel
 Instill 1 drop into the lower conjunctival sac 6-24 hourly
Carmellose (Carboxymethylcellulose sodium)
 0.5%, 1% ophthalmic drops; 0.5%, 1% preservative-free ophthalmic drops  Instill 1-2 drops as needed Adverse Reactions
  • Eye irritation and allergic reactions have been reported occasionally
Special Instructions
  • Avoid the eyedropper tip to come in contact with the eyes
  • Discontinue if symptoms persist or worsen >72 hours
Diquafosol Na  3% ophthalmic solution
 Instill 1 drop 4 hourly
 Adverse Reactions
  • Ocular effects (blepharitis, irritation, conjunctival injection, discharge, pruritus, ocular discomfort, foreign body sensation in the eyes)
Special Instructions
  • Avoid the eyedropper tip to come in contact with the eyes
Glycerin/Polysorbate 80  Glycerin 1%/Polysorbate 80 1% ophthalmic drops  Instill 1-2 drops as needed
 Adverse Reactions
  • Eye irritation and allergic reactions have been reported occasionally
Special Instructions
  • Avoid the eyedropper tip to come in contact with the eyes
  • Discontinue if symptoms persist or worsen >72 hours
Hypromellose
(Hydroxypropyl methylcellulose) 		 0.3%, 0.5% ophthalmic drops
Instill 1-2 drops 6-8 hourly or as needed
 Adverse Reactions
  • Temporary burning or stinging sensation, allergic reactions, redness of eyes
Special Instructions
  • Use with caution when driving or operating machines
  • Avoid the eyedropper tip to come in contact with the eyes
  • Discontinue if symptoms persist or worsen
Naphazoline 0.012% ophthalmic drops  Instill 1 drop up to 6 hourly
 Adverse Reactions
  • Ocular effects (temporary visual disturbances, pupil enlargement, eye redness, irritation, eye pain)
Special Instructions
  • Avoid use while wearing contact lenses
Perfluorohexyloctane  1.338 g/mL ophthalmic drops
 Instill 1 drop 6 hourly  Adverse Reactions
  • Ocular effects (blurred vision, conjunctival erythema)
Special Instructions
  • Avoid use while wearing contact lenses
Polyethylene glycol
 0.25% ophthalmic drops
 Instill 1 drop as needed  Special Instructions
  • Avoid eyedropper tip to come in contact with the eyes
  • Blink several times after administration
Polyvinyl alcohol
 1.4% ophthalmic drops  Instill 1 drop as needed  Adverse Reactions
  • Eye irritation and allergic reactions have been reported occasionally
Special Instructions
  • Avoid eyedropper tip to come in contact with the eyes
  • Avoid use while wearing contact lenses
  • Discontinue if symptoms persist or worsen >72 hours
Propylene glycol 0.6% ophthalmic drops  Instill 1-2 drops as needed  Special Instructions
  • Avoid eyedropper tip to come in contact with the eyes
  • Discontinue if symptoms persist or worsen
*Various combination products are available. Please see the latest MIMS for specific formulations.

Other Eye Preparations*


Drug Available Preparation
 Dosage Remarks
Sodium chloride 0.9% ophthalmic drops

Instill 1 drop as needed

  Special Instructions
  • Avoid eyedropper tip to come in contact with the eyes
  • Avoid use while wearing soft contact lenses
Sodium hyaluronate
 0.1% ophthalmic solution

Instill 1 drop 5-6x/day

Adverse Reactions

  • Ocular effects (blepharitis, eyelid dermatitis, itching, irritation, conjunctivitis, conjunctival injection, corneal lesions eg keratitis, superficialis diffusa, eye discharge)
Special Instructions
  • Use 0.3% ophthalmic solution if 0.1% ophthalmic solution is ineffective
  • Avoid the eyedropper tip to come in contact with the eyes
  • Avoid use while wearing soft contact lenses

 
0.3% ophthalmic solution Instill 1 drop 5-6x/day

0.18% , 0.2% ophthalmic drops, 0.18% preservative-free ophthalmic drops
 Instill 1-2 drops as needed 
0.3% preservative-free ophthalmic gel Instill 1-2 drops as needed 
*Various combination products are available. Please see the latest MIMS for specific formulations.

Other Parasympathomimetic
Drug Dosage Remarks
Secretagogue
Pilocarpine Initial dose: 5 mg PO 8 hourly
Maintenance dose: 15-30 mg/day
Max dose: 10 mg/dose		 Adverse Reactions
  • Systemic cholinergic effects (sweating, nausea, intestinal cramping)
Special Instructions
  • Avoid use in patients with hypersensitivity to Pilocarpine or any component of the formulation
  • Use with caution in patients with cognitive or psychiatric disorders, renal impairment, biliary tract disorders
  • Titrate dose according to response and tolerability
Varenicline 1 spray each nostril 12 hourly Adverse Reactions
  • Respiratory effects (cough, sneezing, throat irritation); Other effect (local site irritation)
Special Instructions
  • Avoid shaking the bottle and spraying directly at nasal septum

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