Restasis is a popular prescription eye drop used to treat chronic dry eye by increasing the production of natural tears. Understanding the possible Restasis side effects is important in order to make an informed decision about its use.
The side effects of Restasis can range from mild to severe, with the most common side effects being relatively mild in nature. According to clinical studies, approximately 17% of patients using Restasis may experience eye burning or stinging, one of the frequently reported Restasis side effects. This sensation typically occurs upon application and can last for a few minutes. However, the severity and duration of the burning or stinging sensation may decrease over time as the body becomes accustomed to the medication. It is important to note that if this side effect persists or worsens, patients should consult our optometrist for further evaluation.
Another common side effect of Restasis is eye redness, which occurs in roughly 15% of patients. This redness may be accompanied by itching, which can be a sign of an allergic reaction. If a patient experiences severe itching or if the redness worsens, they should consult our optometrist to determine if an alternative treatment might be more suitable. In some cases, patients may also develop eye discharge or watery eyes. Although this is a less common side effect, affecting approximately 5% of patients, it is essential to monitor the condition and consult a healthcare professional if the discharge becomes persistent or changes in color or consistency.
In clinical trials, the most frequently reported side effect of Restasis was a temporary burning or stinging sensation in the eyes upon instilling the drops. In fact, about 17% of patients experienced ocular burning in studies (similarly, a recent analysis found ~14.7% incidence of burning with Restasis vs ~6.5% with placebo). This burning/stinging is usually mild and brief, occurring right after the drop is applied, and tends to subside within minutes. Importantly, most people do not find it severe enough to stop using Restasis, and this sensation often improves with continued use over time, one long-term study noted patients reported less burning after 3 years of use compared to 1 year. Below is a list of common Restasis side effects:
All of the above side effects are localized to the eye and are generally mild to moderate in intensity. It’s worth noting that many of these effects, burning, redness, grittiness, blurred vision, are also symptoms of dry eye disease itself. So when you start Restasis, you might already have some of these symptoms from dry eye, and the drop may transiently accentuate them.
With consistent use over weeks to months, as Restasis reduces ocular surface inflammation, dry eye symptoms (and these side effects) tend to improve. In clinical trials, most adverse events were reported as mild, and very few patients (only about 1–2%) discontinued Restasis due to side effects. In other words, most people find the side effects tolerable enough to continue therapy while their eyes gradually get healthier.
Serious adverse reactions to Restasis are very rare. There are a few precautions to be aware of, mostly related to proper use of the eye drops and potential allergies:
Restasis itself does not cause eye infections, but improper handling of the bottle or vials can introduce bacteria to your eye. If the tip of the dropper touches your eye or any surface, it can contaminate the medication. Using a contaminated dropper could lead to bacterial eye infection, such as conjunctivitis (pink eye). Signs of infection include increasing eye redness, thick or yellow discharge, swelling, and eye pain that doesn’t resolve. Prevent this by always washing your hands before use, avoiding touching the dropper tip to anything (including your eye or eyelids), and discarding single-use vials immediately after one use. Restasis is available in preservative-free single-use vials and a multi-dose bottle; if using the multi-dose bottle, keep the tip sterile and the cap on tightly when not in use. Eye infections from Restasis use are rare and generally only happen if there’s contamination, so correct technique is key. If you suspect an infection (e.g. sudden pain, one eye becoming very red and irritated, pus-like discharge), stop using the drops and contact your eye doctor for evaluation.
Similarly, eye injury is not a direct effect of the drug but can occur if the dropper is not used carefully. Accidentally poking or scratching the eye with the vial tip can cause a corneal abrasion or other injury. Always instill the drops cautiously: tilt your head back, hold the dropper above the eye without touching it, and let a drop fall in. If you have unsteady hands or poor dexterity, ask your provider about assistive eye drop devices or have someone help you apply the drops to avoid injury. Severe eye pain or significantly blurred vision after using a drop could indicate an injury, seek medical attention if you suspect you’ve injured your eye.
True allergies to Restasis (cyclosporine) are extremely uncommon, but post-marketing reports have noted rare cases of hypersensitivity reactions. This could manifest as swelling of the face, eyelids, or around the eyes, hives, or difficulty breathing in severe cases. If after using Restasis you experience extensive swelling (e.g. your eyelids or lips puff up) or any trouble breathing, it could be a sign of a serious allergic reaction (angioedema), and you should seek emergency medical care. Fortunately, such reactions are very rare. Mild eye-area swelling or redness is more likely due to local irritation than a true allergy, but it’s wise to have any concerning symptoms checked by a physician.
Because this information is for a contact lens clinic’s patient page, it’s important to discuss how Restasis use intersects with contact lens use:
You should not instill Restasis while wearing contact lenses. The medication contains an emulsifying agent and, while it’s formulated to be gentle on the eye, contact lenses can interfere with the drop’s distribution and may absorb ingredients. Moreover, many dry eye patients probably shouldn’t be wearing contacts until their condition improves. If you do wear contacts, take them out before putting in Restasis, and wait at least 15 minutes after the drop before reinserting your lenses. This waiting period allows the medication to fully absorb into the ocular surface. Following this rule will help avoid any interaction between the drop and your lenses (and also ensures the drop isn’t diluted or removed by the lens).
Unlike something that gives immediate relief (like artificial tears), Restasis works by gradually changing the tear production and inflammation in your eyes. It often takes several weeks (up to 3–6 months) to notice substantial improvement in dry eye symptoms. During the early phase of treatment, the common side effects (burning, etc.) might be more noticeable, but don’t give up too soon. Eye doctors note that “Restasis burns… until it doesn’t”, in other words, if you can tolerate the initial discomfort, it usually lessens with time and the benefits for your dry eye can be significant. Only a small fraction of patients end up discontinuing Restasis due to side effects in clinical trials, which suggests that with proper guidance most people can manage the temporary side effects.
If the drops sting, remember the refrigeration tip mentioned above, a slightly chilled drop can be more soothing on instillation. Using preservative-free artificial tears in between Restasis doses (spaced at least 15 minutes apart from Restasis) may also help keep your eyes comfortable as you adjust. Just be sure to separate any lubricant drops from your Restasis dose by at least 15 minutes (Restasis is typically twice a day, e.g. morning and evening) so that the artificial tear doesn’t wash out the medication. If you experience mild blurred vision after dosing, plan your day so that you’re not immediately driving or doing something visually intensive right after putting in the drops, giving it a few minutes to clear. And as always, regular follow-ups with your eye care provider are important: they can check your progress, ensure you’re using the drops correctly, and address any persisting side effect that concerns you.
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