Dry eye syndrome, or simply dry eyes, occurs when your tear ducts don’t produce enough tears to keep the surface of your eyes adequately moist. Experts estimate that 20 to 40 million adults in the United States have dry eye syndrome.

You can usually treat mild dry eyes with over-the-counter (OTC) eye drops. If you don’t respond to these drops, a doctor or healthcare professional may prescribe a stronger medication.

Tyrvaya is a prescription nasal spray the Food and Drug Administration (FDA) approved in 2006 to treat dry eyes. It contains the active ingredient varenicline. It offers a potentially effective alternative to medicated eye drops and has a low risk of side effects.

Read on to learn how varenicline can treat dry eyes and how it compares with other dry eye treatments.

Tyrvaya is the brand name for a nasal spray the FDA approved to treat dry eyes. It contains the active ingredient varenicline. Varenicline is currently only sold under the brand name Tryvaya for treating dry eyes. It’s also available as an oral tablet under the brand name Chantix to help with smoking cessation.

Experts do not fully understand how varenicline helps treat dry eyes. They believe it binds to nicotine acetylcholine receptors, stimulating the nerves that are connected to your tear ducts and causing them to produce tears.

Studies suggest that Tyrvaya can potentially be an effective and well-tolerated treatment. A phase 3 clinical trial in 2022 found that 4 weeks of Tyrvaya led to significant improvements in natural tear production and self-reported symptoms of dry eyes. There were no reports of serious side effects considered relevant to the drug.

What causes dry eye syndrome?

Dry eyes occur when your body doesn’t produce enough tears to keep the surface of your eyes moist. According to the National Eye Institute, risk factors include:

Other factors that increase your chances of developing dry eyes include:

  • exposure to smoke
  • looking at a screen for long periods without taking breaks
  • exposure to dry air

Each spray of Tyrvaya contains 5 mL of fluid and 0.03 mg of the active ingredient varenicline. Before using the container for the first time, you should prime the spray by pumping seven sprays in the air away from your face.

You should spray the medication into each nostril twice per day, roughly 12 hours apart. If you miss a dose, you can skip it and take it at your next scheduled time. You shouldn’t take an extra dose.

It’s best to store the nasal spray between 68°F and 77°F (20ºC and 25ºC). Don’t freeze the spray. You should throw the container away 30 days after opening it.

The most commonly reported side effect in clinical trials was sneezing, which occurred in 82% of people. Other side effects reported by more than 5% of people included:

  • Coughing: 16%
  • Throat irritation: 13%
  • Nose irritation: 8%
When to contact a doctor

Severe allergic reactions to Tyrvaya are rare, but you should contact a doctor if you develop symptoms of an allergy such as:

  • rash
  • chest or throat tightness
  • swelling in your throat, mouth, or face
  • red and blistering skin
  • trouble breathing
  • any other concerning symptoms

It’s important to call 911 or your local emergency services right away if you have trouble breathing or other serious side effects.

The FDA doesn’t list any health conditions that make you ineligible for Tyrvaya. But so far, there have been no studies of its safety in children or in lactating or pregnant people.

It’s important to ask a doctor if Tyrvaya is safe before taking it if you fall into one of these categories.

The FDA doesn’t list any known interactions for Tyrvaya. Still, it’s a good idea to let a doctor know about any other drugs or supplements you’re taking prior to taking Tyrvara.

One of the advantages of Tyrvaya is that it might help eliminate symptoms such as eye burning or irritation that may occur after taking eye drops.

A 2022 analysis of clinical trial data found evidence that varenicline is more effective than lifitegrast (Xiidra) eye drops. But it’s worth noting that all the researchers received funding from, worked for, or consulted for the company that produces Tyrvaya.

Here’s a look at how Tyrvaya compares with other treatment options.

  • Behavior changes: Taking more frequent breaks when looking at a screen and taking steps to avoid dry air might offer relief if these factors are contributing to your dry eyes.
  • OTC eye drops: OTC eye drops can offer relief but aren’t as strong as prescription medications. They may make a good initial treatment option.
  • Cyclosporine (Restasis): Cyclosporine is a prescription eye drop. In a 2017 study, researchers found that improvements after cyclosporine treatment were sustainable long term, with a few people requiring additional treatment.
  • Lifitegrast (Xiidra): Lifitegrast is another prescription eye drop. According to the authors of a 2019 study, Lifitegrast may be an effective option for people who don’t respond to OTC eye drops.
  • Tear duct plugs: Tear duct plugs are tiny silicone or collagen plugs that go into the corner of your eyes to help conserve your tears and eye drops. They may be an option if other eye drops don’t offer relief.
  • Surgery: Surgery may be an option if you have severe dry eyes that don’t respond to other treatments. Doctors may recommend it for people with an underlying condition, such as Stevens-Johnson syndrome, that causes dry eyes.

Here are some frequently asked questions people have about Tyrvaya for treating dry eyes.

Do I need a prescription for Tyrvaya?

Tyrvaya is only available by prescription at this time.

How much does Tyrvaya cost?

According to the Tyrvaya website, your commercial insurance may cover the entire cost and may lead to savings of up to a maximum of $275 per 30-day prescription. You can pay as little as $10 per prescription while your insurance company processes your coverage.

Is Tyrvaya available in generic form?

There’s currently no generic form of Tyrvaya available in the United States.

If I sneeze, should I take another dose of Tyrvaya?

In clinical trials, researchers instructed participants not to repeat their dose if they sneezed.

How long does it take for Tyrvaya to work?

Tyrvaya is meant as a long-term treatment. It starts working to increase your tear production within hours after your first dose. A 2022 study found rapid and meaningful improvements over a 4-week period.

Can I use Tyrvaya nasal spray in my eyes?

Tyrvara is meant to be inhaled through your nose. You shouldn’t spray it directly in your eyes.

Does the FDA recall of Chantix apply to Tyrvaya?

In 2021, Pfizer recalled all their Chantix tablets due to the presence of N-nitroso-varenicline levels above FDA-acceptable limits. This recall doesn’t affect Tyrvaya.

Tyrvaya is a nasal spray that may offer relief from dry eyes. Studies suggest that it can provide significant results with a low risk of side effects. An advantage of Tyrvaya over eye drops is that it may help avoid further eye irritation.

Tyrvaya is only available by prescription. A doctor can help you decide if Tyrvaya is the right treatment option for you.