What to Know About Cequa (Cyclosporine Ophthalmic Solution)

A Cyclosporine Drop for Patients With Tear Deficiency

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For those who suffer from dry eye as a result of insufficient tears, the use of Cequa eye drops may provide relief for some. This cyclosporine agent is approved to increase the production of tears when someone does not produce enough of these.

As a cyclosporine, Cequa is part of the calcineurin inhibitor immunosuppressant class, which works to suppress the immune system. If your tear production has been reduced as a result of ocular inflammation, Cequa helps to tamp this down by modulating the immune system. However, the full mechanism here is unclear.

Woman squeezing a drop from a single-use vial into her eye

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Dry eye, also known as keratoconjunctivitis sicca, is actually a multifactorial condition that can come in different forms. The two main types are aqueous tear deficiency and evaporative dry eye.

The medication Cequa, which comes as a solution, is used for those who have a form of dry eye with an inadequate tear film caused by the production of too few tears. It is recommended for more severe cases.

A generic version of the active cyclosporine ingredient is also available, known as cyclosporine ophthalmic solution. This, however, does not have the same type of vehicle that helps with the absorption of the cyclosporine that the brand version does.

Before Taking

In most cases, individuals with dry eye can take Cequa without issue; however, anyone who has had any problem with cyclosporine medication previously should discuss this with their healthcare provider. In addition, be sure to mention any other allergies you may have to other medications, foods, or dyes before taking this medication.

Cequa is different than other cyclosporine solutions due to the fact that it offers the highest concentration of cyclosporine A (CsA) and is the only one in solution with nanoparticles. These nanoparticles help the cyclosporine to effectively penetrate the aqueous layers of the eye.

Before taking Cequa, it's important to talk to your healthcare provider about any other medications, supplements, or vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Precautions and Contraindictions

If you are currently pregnant, it's also important to alert your eye healthcare provider. While Cequa is a topical drop, this has not been adequately studied in pregnant people to be clear whether it might pose a risk to the fetus.

Likewise, anyone who is breastfeeding should discuss options with the prescribing healthcare provider. There is no data available to determine whether this might impact the nursing infant.

Also, for administering Cequa in children under the age of 18, the safety and efficacy of this have not yet been determined.

However, Cequa has been found to be just as safe and effective in those over the age of 65 as in other adults.

Other Ophthalmic Cyclosporines

In addition to Cequa, the ophthalmic cyclosporine Restasis may also be prescribed in cases of dry eye caused by tear deficiency. Restasis was the first cyclosporine drop to be approved by the Food and Drug Administration (FDA). Unlike Cequa, Restasis is an oil-in-water emulsion.


This ophthalmic solution with cyclosporine has a strength of 0.9 milligrams per milliliter (mL). The manufacturer recommends that one drop of Cequa be placed in each eye twice each day. This should be done at 12-hour intervals.

How to Take and Store

Before taking Cequa, be sure to remove your contact lenses first and leave them out for at least 15 minutes after putting in the drops.

Cequa is preservative-free and comes in a single-use vial, which contains 0.25 mL of solution. There are 60 single-use vials in a box.

When taking the drop, first wash your hands. Also, be careful not to inadvertently touch the tip of the container to any surfaces, including the eye itself. Otherwise, this may become contaminated.

To place a drop in the eye, tip the head back and gently pull the lower lid down slightly. Then squeeze one drop into the eye and briefly shut the eyelid, gently pressing the corner near the tear duct. Throw out the vial once this is administered.

According to the manufacturer, using Cequa in conjunction with artificial tears is permissible as long as there is at least a 15-minute gap between administering the two drops.

If you miss a dose of Cequa, try to take this as soon as you remember. However, if this is just before the second dose, don't double up; simply wait and take the drop at the appropriate time.

The package of single-use vials in the original foil pouch should be stored at between 68 degrees and 77 degrees Fahrenheit.

Side Effects

While most people do well with the drops, some may experience some adverse reactions. Here's what to watch for.


Common side effects include:

  • Pain or stinging when placing the drop in the eye
  • Eye redness
  • Blepharitis (eyelid inflammation)
  • Eye irritation
  • Headache


One slightly more severe systemic side effect, urinary tract infection, was not common but occurred in a small number of cases in the FDA clinical trials. If such side effects appear to worsen with time, be sure and alert your eye healthcare provider about this.

While it is very rare to have an allergic reaction to Cequa or any of its components, call your practitioner or seek emergency help right away if you show signs of an anaphylactic allergic reaction to the medication. These may include:

  • Rash or hives
  • Peeling or blistered skin
  • Itching
  • Tightness in the throat or chest
  • Hoarseness
  • Difficulty breathing, swallowing, or talking
  • Swelling around the face, mouth, tongue, lips, or throat

If you have any such signs, do not wait. Reach out for emergency assistance immediately.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Center for Drug Evaluation and Research. Labeling.

  2. American Academy of Ophthalmology. A quick guide to dry eye.

  3. University of Michigan. Cyclosporine ophthalmic.

  4. de Oliveira RC, Wilson SE. Practical guidance for the use of cyclosporine ophthalmic solutions in the management of dry eye disease. Clin Ophthalmol. 2019;13:1115-1122 doi:10.2147/OPTH.S184412

  5. Review of Optometry. Cequa gets approved for dry eye.

  6. Memorial Sloan Kettering Cancer Center. Cyclosporine (ophthalmic).

By Maxine Lipner
Maxine Lipner is a long-time health and medical writer with over 30 years of experience covering ophthalmology, oncology, and general health and wellness.