Dry Eye Treatment Options Explained: OTC vs. Prescription Eye Drops, Punctal Plugs, Lacrifill, and IPL

Dry eye is a common condition that can cause burning, irritation, blurry vision, redness, and the feeling that something is stuck in the eye. For some patients, occasional symptoms can be managed with artificial tears. For others, eye dryness persists despite using over-the-counter products.

Fortunately, dry eye treatment now extends well beyond artificial tears. Prescription eye drops can target specific processes involved in dry eye disease, while treatments such as punctal plugs and Lacrifill can help preserve tears.

Understanding the differences between OTC vs. Rx treatments, and why an eye doctor might recommend one treatment over another, can make the growing number of options easier to navigate.

Dry eye may sound like a simple problem: the eyes don't have enough moisture. In reality, a healthy tear film is complex, and dry eye disease can develop for several different reasons.

Some people don't produce enough tears. This is known as aqueous-deficient dry eye. Others produce tears, but they evaporate from the surface of the eye too quickly. This is known as evaporative dry eye.

Inflammation can also play an important role in dry eye disease, and many patients have more than one contributing factor. This is why two people with similar dry eye symptoms may benefit from very different treatments.

The biggest difference between OTC vs. Rx eye drops is what they are designed to accomplish. Over-the-counter artificial tears primarily lubricate the surface of the eye and supplement natural tears. They can provide effective relief from mild or occasional symptoms, but the effects are often temporary.

Prescription eye drops can go further by targeting specific mechanisms involved in dry eye disease. Depending on the medication, a prescription eye drop may help address inflammation, increase tear production, or reduce excessive tear evaporation.

This means the distinction isn't simply that prescription drugs are "stronger" versions of artificial tears. They may work in fundamentally different ways. The appropriate option depends on the symptoms, severity, and factors responsible for a patient's dry eye.

Artificial tears are one of the most common treatments for dry eye and are available without a prescription. They add lubrication to the ocular surface and can temporarily relieve symptoms such as dryness, burning, irritation, or a gritty sensation.

There are many different types of artificial tears. Some are thinner and designed for use throughout the day, while thicker drops and gels may provide longer-lasting relief. Some formulations also contain ingredients designed to support different layers of the tear film.

For occasional eye dryness, artificial tears may be all that's necessary. However, needing drops constantly or continuing to experience symptoms despite using them can be a sign that it's time to visit an eye doctor and investigate the underlying cause.

When artificial tears aren't providing sufficient relief, prescription eye drops may be considered. Several medications are available, and they don't all treat dry eye in the same way.

Xiidra is the brand name for lifitegrast ophthalmic solution. It is FDA-approved to treat the signs and symptoms of dry eye disease.

Xiidra targets an inflammatory pathway involved in dry eye. By interfering with this process, the medication can help reduce inflammation associated with the condition.

It is typically used twice daily. Some of the most common side effects include irritation or discomfort after the drops are applied, as well as an unusual or altered taste.

Cequa is a prescription formulation of cyclosporine. It is FDA-approved to increase tear production in patients with keratoconjunctivitis sicca, a condition associated with dry eye.

Cyclosporine helps address inflammation that can interfere with normal tear production. Like Xiidra, Cequa is generally administered twice daily.

One of its more common side effects is pain or discomfort when the drops are instilled in the eyes. Redness and irritation can also occur.

Miebo, or perfluorohexyloctane ophthalmic solution, takes a different approach to dry eye treatment.

Rather than primarily targeting inflammation or increasing tear production, Miebo helps reduce tear evaporation from the ocular surface. This makes its mechanism particularly relevant to evaporative dry eye, including cases in which meibomian gland dysfunction contributes to an unstable tear film.

Miebo is FDA-approved to treat the signs and symptoms of dry eye disease and is typically used four times per day. Blurry vision is among its most commonly reported ocular side effects.

Tryptyr is a newer prescription treatment for dry eye disease. The FDA approved acoltremon ophthalmic solution in 2025 for the treatment of the signs and symptoms of dry eye disease. It is generally administered twice daily.

Tryptyr activates TRPM8 receptors, which are involved in sensing temperature and regulating tear production. Activating these receptors stimulates the body's natural tear-production pathway rather than simply adding artificial tears to the eye.

Another way to treat dry eye is to preserve the tears the eyes already produce. Tears normally drain through small openings called puncta located near the inner corners of the eyelids. From there, they travel through the tear drainage system and eventually drain toward the nose.

Punctal plugs are tiny devices inserted into these openings to slow or block that drainage. With less tear fluid leaving the eye, natural tears can remain on the ocular surface longer.

Different types of plugs are available. Temporary plugs are generally made from materials that dissolve over time, while longer-lasting plugs may remain in place until they fall out or are removed.

Placement can usually be performed in an eye doctor's office in just a few minutes. Some patients experience irritation, excessive tearing, or plugs falling out prematurely. More significant complications, such as infection or plugs becoming lodged within the drainage system, can occur in rare cases.

Punctal plugs can benefit some patients, although clinical studies have produced mixed evidence regarding how consistently they improve dry eye symptoms.

Lacrifill is another treatment designed to help natural tears remain on the eye longer, but it works differently from traditional punctal plugs.

Instead of placing a small solid device into the punctal opening, Lacrifill uses a cross-linked hyaluronic acid gel that fills the canalicular system. The material temporarily blocks tear drainage, allowing tears to remain on the ocular surface.

The procedure is performed in a doctor's office and does not require a patient to insert drops throughout the day. Lacrifill is an FDA-cleared medical device rather than a prescription medication. Like punctal plugs, its goal is tear conservation rather than directly stimulating the body to produce more tears.

This approach may be an option for eligible patients when an eye doctor determines that reducing tear drainage could benefit their particular form of dry eye.

For patients with evaporative dry eye, treatment may need to focus on the meibomian glands rather than simply adding or conserving tears. IPL, or intense pulsed light, is one treatment that may be used for dry eye associated with meibomian gland dysfunction.

The meibomian glands are located along the eyelids and produce oils that form the outer layer of the tear film. These oils slow evaporation. When the glands become blocked or their secretions change, tears may evaporate too quickly, causing irritation and other dry eye symptoms.

IPL delivers controlled pulses of light to the skin around the treatment area. Treatment protocols vary, and patients typically receive multiple sessions rather than a single treatment.

Because IPL addresses specific factors associated with evaporative dry eye, it isn't appropriate for every patient with dry eye disease. An eye examination can help determine whether meibomian gland dysfunction is contributing to the symptoms and whether IPL or another treatment may be appropriate.

There is no single dry eye treatment that works best for every patient. Instead, treatment should address the factors contributing to the condition.

• For mild or occasional eye dryness: OTC artificial tears may provide enough lubrication and relief.
  

• For persistent dry eye involving inflammation or impaired tear production: prescription medications such as Xiidra or Cequa may be considered. Tryptyr offers another prescription approach by stimulating natural tear production.
  

• For excessive tear evaporation, Miebo may help address the evaporative component of dry eye.
  

• For patients who could benefit from keeping existing tears on the ocular surface longer: punctal plugs or Lacrifill may be considered.
  

• When meibomian gland dysfunction contributes to evaporative dry eye: IPL may be one of the treatment options an eye doctor recommends.

These categories aren't mutually exclusive. Dry eye frequently involves multiple factors, so patients may benefit from a combination of treatments rather than a single solution.

Occasional mild dryness can often be managed with artificial tears and changes to everyday habits. Persistent symptoms deserve more attention.

Consider seeing an eye doctor if:

• Dry eye symptoms continue despite OTC treatment or other at-home measures

• Artificial tears are needed very frequently

• Symptoms interfere with everyday activities or make it difficult to wear contact lenses

• You experience significant pain, burning, irritation, redness, or changes in vision

An eye examination can provide more information about the ocular surface, tear production, eyelids, and meibomian glands.

This allows treatment to focus on what's actually contributing to the problem instead of repeatedly trying different eye drops without knowing the cause.

The choice between OTC vs. Rx dry eye treatment isn't a question of which option is stronger. Artificial tears can provide effective relief for mild or occasional dryness.

When symptoms persist, prescription eye drops such as Xiidra, Cequa, Miebo, and Tryptyr can target different processes involved in dry eye disease. Punctal plugs and Lacrifill offer ways to conserve tears, while IPL can address meibomian gland dysfunction in appropriate patients.

The key is determining why the eyes are becoming dry in the first place. Once the underlying factors are identified, an eye doctor can recommend the treatment, or combination of treatments, best suited to addressing them.