Cequa vs Restasis vs Xiidra, Which Works Better?

written by Dr. Bolanle Aina - Dec 19, 2022

Photo Credit: by Jcomp, Freepik.com
Photo Credit: by Jcomp, Freepik.com

Dry eyes disease can be quite annoying, especially if you do not know how to manage it. According to studies, approximately 6 million Canadian adults and nearly 16.4 million US adults suffer from dry eye disease. Individuals with dry eyes do not produce enough tears because of inflammatory changes in their eyes. If you ever notice symptoms of dry eyes such as redness, pain, watery eyes and burning or itchy sensations in the eye, it is time to get your eyes checked by the doctor.

There are numerous treatment options for dry eye disease. As a first step, doctors will recommend using lubricant eyedrops or artificial tears. But when these do not help, doctors typically prescribe eye drop medications to treat clinical cases of dry eyes. Sometimes dry eyes also occur in addition to other eye conditions. When all underlying conditions have been ruled out, common eye drops medications such as Cequa, Restasis, and Xiidra are typically efficacious for dry eye disease.

How do these eye drops work, and which is better for dry eye disease?

Read to learn more about Cequa, Restasis, and Xiidra, their side effects, and their active ingredients.


Cequa is an eye drop solution that suppresses immune-mediated reactions in the eyes. It helps to reduce local eye inflammation and typically suppresses the discomfort associated with dry eyes. Cequa eye solution comes at a dose of 0.9mg/ml. For treating dry eyes, doctors prescribe one drop twice daily with an interval of 12hrs between doses.

Safety precautions when using Cequa

* Do not allow the vial tip to touch your eyes because of the risk of eye injury and contamination.

* Do not apply Cequa if your contact lens is intact. Experts recommend removing the contact lens first before applying and reinserting the contact lens at least 15mins after application.

Cequa side effects

* eye redness

* eye irritation

* headache

* urinary tract infection.


Restasis is another choice of eye drop medicine that reduces the local inflammation associated with dry eyes. Restasis eye solution comes at a dose of 0.5mg/ml, a drop applied twice daily with an interval of 12hrs between doses typically reduces dry eyes.

Safety precautions when using Restasis

* Avoid direct eye contact with the vial tip to prevent eye injury.

* Doctors do not recommend Restasis for individuals vulnerable to allergic reactions.

Restasis side effects

The following hypersensitivity reactions and adverse effects have been reported with Restasis:

* eye swelling

* itchy and swollen skin rashes(urticaria)

* face and tongue swelling

* swelling in the pharynx or throat

* difficulty breathing

Of note, some of these symptoms are life-threatening and require prompt therapeutic intervention if noticed. However, these adverse reactions occur sparingly.


Xiidra is also an eye drop medication for dry eye disease. It contains an active ingredient called lifitegrast, which helps to relieve the distressing feeling of dry eyes. Lifitegrast acts by binding to a cellular protein in the eyes and inhibiting the immune signals responsible for inducing inflammation in the eyes. Xiidra eye solution comes at a dose of 50mg/ml to be appled twice daily with an interval of 12hrs between doses.

Safety precautions when using Xiidra

* It comes in a single-use container, so discard it immediately after initial use.

* Do not apply Xiidra if you use a contact lens.

Xiidra side effects

Clinical trial studies have reported the following side effects of Xiidra in some individuals:

* irritation at the application site

* blurred vision

* eye redness

* eye irritation

* headache

* eye discharge and discomfort

* itching in the eye

* inflammation of the sinus (sinusitis)

Similarities of Cequa, Restasis, and Xiidra

The major similarity in these three eye drops is that they have active ingredients that reduce inflammation—the primary mechanism behind dry eye disease.

Another uniform similarity is that these eye drops are applied twice daily- one drop 12 hours apart.

Also, Cequa and Restasis both contain an immunosuppressant called cyclosporine, which reduces eye inflammation. In addition, Restasis and Xiidra typically come in single-use vials.

Finally, health authorities approve these eye drops for the treatment of dry eye disease.

Differences between Cequa, Restasis, and Xiidra

Although these eyes drop medications are equally efficacious in treating dry eye disease, they differ slightly in their active components, mechanisms of action, physical forms and side effects.

Cequa and Restasis both have cyclosporine as the active ingredient, while Lifitegrast is the active component of Xiidra. The main difference between Cequa and Restasis is that Cequa comes as a liquid solution in a single use vial while Restasis come as an emulsion, which appears as an oily and thick solution in both single vial and multidose vials. Because Cequa is a solution, it is believed to have better absorption into the eye tissue but there is no evidence that it is more efficacious than Restasis.

Cyclosporine in Cequa and Restasis works by inhibiting specific chemicals responsible for eye inflammation and swelling via a different biochemical pathway. In contrast, Lifitegrast in Xiidra works via a unique different pathway to reduce inflammation.

Xiidra is used in ages 17 years and older, Cequa in ages 18 years and above while Restasis and is used in ages 16 years and above. Another major difference and factor to consider is the cost of the medications. Cequa and Xiidra are significantly more expensive than Restasis. Xiidra may reach maximum effect much sooner than Restasis and Cequa.

Cequa Vs. Restasis Vs. Xiidra-which should you choose?

The three eye drop medications for dry eye disease are all efficacious, so it can be challenging to choose one. It is best to consult your doctor to decide which one will suit your unique health needs, based on your age, medical conditions, allergy history e.t.c. For instance, your doctor will take a clinical history to ensure you do not have a history of allergy before prescribing. This is because allergic or hypersensitivity reactions in vulnerable people may be life-threatening. Hence, speak with your doctor to select the right eye drop medication for you.



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While the above article is based on thorough research, we do not claim to offer a substitute for medical advice from a qualified healthcare provider. The article was written for information and educational purposes only. We aim to provide helpful information to our readers, but cannot provide a treatment, diagnosis, or consultation of any sort, and we are in no way indicating that any particular drug is safe or appropriate for you and your individual needs. To receive professional medical attention, you must see a doctor.