When Restasis Isn't an Option, What Are Your Choices?

If you've been prescribed Restasis for chronic dry eye but can't fill your prescription — whether it's out of stock, too expensive, or not covered by your insurance — you're probably wondering what else is out there.

The good news is that several effective alternatives exist. Some work similarly to Restasis, while others take a completely different approach to treating dry eye. In this article, we'll explain what Restasis is, how it works, and walk you through the best alternatives available in 2026.

What Is Restasis?

Restasis is the brand name for Cyclosporine ophthalmic emulsion 0.05%. It was one of the first prescription eye drops specifically designed to treat the underlying cause of chronic dry eye — not just the symptoms.

It's manufactured by Allergan (now part of AbbVie) and has been on the market since 2003. Restasis is FDA-approved for patients aged 16 and older whose tear production is suppressed due to ocular inflammation. For a complete overview, see our article on what Restasis is and how to use it.

How Does Restasis Work?

Restasis contains Cyclosporine, a calcineurin inhibitor that acts as a topical immunosuppressant. When applied to the eye, it reduces the inflammation that suppresses your body's natural tear production. Over time — typically 3 to 6 months of consistent use — your eyes begin producing more tears on their own.

Unlike artificial tears that provide temporary moisture, Restasis addresses the root cause of dry eye by calming the immune response on the eye's surface. For a deeper dive, read how Restasis works: mechanism of action explained.

Alternatives to Restasis for Chronic Dry Eye

If you can't get Restasis, here are the most common alternatives your doctor may recommend:

1. Generic Cyclosporine Ophthalmic Emulsion 0.05%

The most direct substitute for Restasis is its generic equivalent. Generic Cyclosporine eye drops contain the exact same active ingredient at the same concentration. They work the same way and are FDA-approved for the same indication.

The biggest advantage? Price. Generic Cyclosporine typically costs $85 to $150 with a discount card, compared to $350 to $410 for brand-name Restasis. If your pharmacy is out of brand Restasis, generic Cyclosporine may be readily available.

2. Xiidra (Lifitegrast)

Xiidra is a prescription eye drop that takes a different approach to treating dry eye. Instead of suppressing the immune system like Cyclosporine, Xiidra is an LFA-1 antagonist. It works by blocking a specific protein on the surface of inflammatory cells, preventing them from binding to eye tissue and causing inflammation.

Key facts about Xiidra:

• FDA-approved in 2016 for dry eye disease
• Dosed as one drop in each eye, twice daily
• Some patients notice symptom improvement within 2 weeks, though full effects may take 6 to 12 weeks
• Common side effects include a temporary taste disturbance (dysgeusia), eye irritation, and reduced visual acuity
• Retail price is similar to brand Restasis (around $500+ per month without insurance)

3. Cequa (Cyclosporine 0.09%)

Cequa is another Cyclosporine-based eye drop, but with an important difference: it uses nanomicellar technology to deliver a higher concentration of Cyclosporine (0.09% vs. Restasis's 0.05%) with better penetration into eye tissue.

Key facts about Cequa:

• FDA-approved for dry eye disease
• Dosed as one drop in each eye, twice daily
• May be more effective for some patients who didn't respond adequately to lower-concentration Cyclosporine
• Common side effects include eye pain, redness, and blurred vision
• Also comes in single-use vials

4. Miebo (Perfluorohexyloctane)

Miebo is one of the newest options for dry eye, FDA-approved in 2023. It takes a completely different approach — rather than targeting inflammation, Miebo is a non-aqueous eye drop that specifically addresses evaporative dry eye by stabilizing the lipid layer of the tear film.

Key facts about Miebo:

• First-in-class treatment targeting tear film evaporation
• Dosed as one drop in each eye, four times daily
• Contains no water, preservatives, or active pharmaceutical ingredient in the traditional sense
• Especially helpful for patients with meibomian gland dysfunction
• Common side effects include blurred vision and eye redness

5. Tyrvaya (Varenicline Nasal Spray)

Tyrvaya is unique among dry eye treatments because it's not an eye drop at all — it's a nasal spray. FDA-approved in 2021, Tyrvaya stimulates tear production by activating the trigeminal nerve pathway through the nose.

Key facts about Tyrvaya:

• Dosed as one spray in each nostril, twice daily
• Works within minutes to stimulate natural tear production
• Good option for patients who can't tolerate eye drops
• Common side effects include sneezing, coughing, and throat irritation

Which Alternative Is Right for You?

The best alternative depends on your specific situation:

• If cost is the main issue: Generic Cyclosporine is your best bet — same medication, much lower price.
• If Restasis didn't work well enough: Cequa (higher-concentration Cyclosporine) or Xiidra (different mechanism) may be worth trying.
• If you have evaporative dry eye: Miebo targets this specific type of dry eye.
• If you can't tolerate eye drops: Tyrvaya nasal spray avoids the eye entirely.

Always discuss these options with your ophthalmologist or optometrist. They can help determine which alternative best fits your diagnosis and medical history.

Final Thoughts

Restasis is an excellent treatment for chronic dry eye, but it's far from your only option. Whether you go with a generic equivalent, a different prescription eye drop, or even a nasal spray, there are effective alternatives available in 2026.

If you're looking for Restasis specifically, try Medfinder to check pharmacy availability near you. And if cost is a concern, our guide on how to save money on Restasis covers coupons, discount cards, and patient assistance programs.