Cyclosporine drops for dry eye: what Cochrane's 58-trial review says, and who they're for

If you have been told your dry eye is "inflammatory", cyclosporine eye drops have probably come up. They are one of the few prescription treatments aimed at a cause of dry eye disease rather than just topping up moisture. In July 2026 the Cochrane Eyes and Vision group published an updated review pooling 58 randomised trials and 10,225 people. Here is what it found, for readers in Hamilton and across New Zealand.

A note on our source: this article is based on the published Cochrane abstract and plain language summary. The full text was not accessible to us, so the authors' declarations of interest, the specific side effects reported and per-study drop-out rates were not available.

What cyclosporine drops are trying to do

Dry eye disease is not only "not enough tears". In many people the eye's surface is chronically inflamed, and that inflammation damages the cells that make and hold tears. Cyclosporine A (CsA) is an anti-inflammatory medicine; as a low-strength drop it aims to calm surface inflammation and support tear production. The trials here mostly tested 0.05% and 0.1%, with a handful at 1% and 2%.

This fits the philosophy behind our treatment approach: treat the cause, not just the symptom. It does not treat blocked oil glands, eyelid mites or incomplete blinking, which is why it belongs after an assessment rather than as a first reflex.

The review in brief

The authors searched the literature up to 17 March 2026 and included randomised trials comparing topical cyclosporine with a "vehicle" (the same drop without the active ingredient), with artificial tears, or with another cyclosporine strength or formulation. Follow-up was typically three months. Median participant age was 53, and women made up about 80% of participants. South Korea, the USA and China contributed 35 of the 58 studies. Cochrane rated its confidence in the results as very low to moderate, marked down for imprecision, risk of bias and inconsistency.

Cyclosporine 0.05% versus placebo drops or artificial tears

• Dry eye symptoms at three months: standardised mean difference (SMD) −0.33, 95% confidence interval −0.65 to −0.01; 13 studies, 1396 participants; low certainty ("may improve").
• Corneal staining (a sign of surface damage): SMD −0.20, 95% CI −0.31 to −0.09; 7 studies, 1355 participants; low certainty.
• Conjunctival staining: SMD −0.21, 95% CI −0.52 to 0.09; 3 studies, 582 participants; low certainty and imprecise.
• Stopping treatment because of unwanted effects: risk ratio 1.99, 95% CI 1.02 to 3.87; 9 studies, 2109 participants; moderate certainty. People on cyclosporine were about twice as likely to stop for this reason, although overall few people stopped.

A word on that "95% confidence interval". An SMD pools symptom scores from trials that used different questionnaires; a negative number favours cyclosporine. The 95% CI is the range within which the true effect most plausibly sits. For symptoms it runs from −0.65 (a moderate benefit) to −0.01 (essentially nothing). It is statistically significant because the range does not cross zero, but only just, and the trials disagreed a great deal (I² = 86%; higher means more inconsistency). That is why Cochrane says "may improve" rather than "improves". Tear production and tear stability results here were too inconsistent for firm conclusions.

Cyclosporine 0.1% versus placebo drops or artificial tears

• Corneal staining: SMD −0.16, 95% CI −0.24 to −0.08; 7 studies, 2940 participants; moderate certainty ("probably improves").
• Conjunctival staining: SMD −0.20, 95% CI −0.28 to −0.12; 5 studies, 2303 participants; moderate certainty.
• Tear production: mean difference 0.66, 95% CI 0.09 to 1.24; 3 studies, 735 participants; low certainty.
• Tear film stability: mean difference 0.15, 95% CI −0.11 to 0.42; 3 studies, 979 participants; low certainty, imprecise.
• Symptoms: the evidence was mixed and the authors could not draw firm conclusions.
• Stopping because of unwanted effects: risk ratio 1.58, 95% CI 1.04 to 2.41; 7 studies, 3051 participants; moderate certainty.

The strongest evidence for 0.1% is for signs the clinician measures (staining), with weaker evidence for how people feel. That gap is why a good dry eye treatment plan tracks both.

Does a different formulation or a higher strength help?

Fourteen trials compared newer formulations (nanoemulsions, cationic emulsions) or other concentrations against 0.05%. Most differences were too imprecise to call. Tear production favoured the newer formulations (mean difference 0.30, 95% CI 0.17 to 0.43; 5 studies, 572 participants; low certainty), but the authors call the difference small. People on the newer formulations were more likely to stop because of unwanted effects (risk ratio 1.72, 95% CI 1.07 to 2.78; 6 studies, 1421 participants; moderate certainty). The 1% and 2% strengths were tested in only one or two small trials (60 and 30 participants) and the evidence is rated very uncertain. Overall, higher concentrations were associated with more people discontinuing treatment.

What the studies can't tell us

• Who benefits most. The trials mixed all types and severities of dry eye; the authors call for future studies to stratify by subtype and severity. Inflammatory, aqueous-deficient dry eye may respond quite differently from evaporative dry eye.
• Long-term outcomes. Follow-up was typically three months; cyclosporine is usually prescribed for much longer.
• Funding. Pharmaceutical companies funded or sponsored nearly half of the included studies; 14 did not report a funding source. Many trials gave few details of their methods.
• What the side effects were. The summary reports discontinuations, not the specific unwanted effects, so we could not verify how common issues such as stinging were.
• Whether cyclosporine beats other approaches. It was compared only with vehicle, artificial tears or other cyclosporine products, not with lid treatments, other medicines or device-based therapies.

What this means if you are considering cyclosporine

The honest summary: cyclosporine drops may modestly improve symptoms and surface signs in dry eye disease, with low-to-moderate certainty, and a small but real chance you will stop them because of unwanted effects. That is a reasonable option for the right person and a poor fit when the dry eye is driven by something the drop does not address. In New Zealand, cyclosporine eye drops are prescription-only; ask your optometrist or ophthalmologist about current availability and funding. Our earlier post on prescribed medicines for dry eye covers where cyclosporine sits alongside other options.

At Rose Optometry in Hamilton, the optometrist team (Jagrut Lallu, Jacqueline Rowe and colleagues) uses a paid Dry Eye Evaluation to work out which causes are driving your symptoms before recommending a prescription drop, lid care or an in-office procedure. Read more about the dry eye clinic. If cyclosporine is part of your plan, expect it to be one part, and expect us to check whether it is working rather than assume it will.

Where to get this looked at

If you live in Hamilton, the two places to start are Rose Optometry in the city, where the optometrist team (Jagrut Lallu, Jacqueline Rowe and colleagues) runs the dry eye clinic, and Visique Rototuna Optometrists on the north side of town. Both are member practices of the Dry Eye Specialist Group and work the same way: a paid Dry Eye Evaluation first, to find out what is actually driving your symptoms, and only then a treatment plan.

If you don't live in Hamilton, see your local Dry Eye Specialist Group member. The group is a network of independent practices across New Zealand that share this treat-the-cause approach: Illume Eye Care (Ponsonby, Auckland), Bay Eye Care (Tauranga), Feilding Visique Optometry, Naylor Palmer Optometrists (Palmerston North), Ashburton Eyecare and Milburn & Neill Optometrists (Dunedin), alongside the two Hamilton practices. Find your nearest one on the member practices page.

Reference

• Priyadarshini SR, et al. Topical cyclosporine A therapy for dry eye disease. Cochrane Database of Systematic Reviews. 2026;7(7):CD010051. PMID 42464966. https://doi.org/10.1002/14651858.CD010051.pub3