CEQUA (Cyclosporine Ophthalmic Solution 0.09%) – Dry Eye Treatment Information, Dosing, and Side Effects

CEQUA is a prescription eye drop used to treat moderate to severe keratoconjunctivitis sicca, more commonly known as dry eye disease. It contains cyclosporine 0.09% in a preservative-free ophthalmic solution designed to help increase tear production in patients whose tear production is reduced because of inflammation associated with dry eye.

Dry eye can cause burning, irritation, blurred vision, redness, a gritty feeling, and discomfort that affects daily life. CEQUA is intended for long-term use in appropriate patients and is applied directly to the eyes twice daily.

What CEQUA Is Used For

CEQUA is indicated to increase tear production in patients with moderate to severe keratoconjunctivitis sicca (dry eye disease).

It is used when dry eye is associated with inflammation that affects the normal function of the tear-producing glands and ocular surface.

How CEQUA Works

CEQUA contains cyclosporine, which acts as an anti-inflammatory and immunomodulating agent in the eye. In dry eye disease, inflammation on the ocular surface can reduce the ability of the lacrimal glands to make enough tears.

By reducing this inflammation, CEQUA helps improve the eye’s ability to produce tears and supports a more stable tear film. This can help relieve symptoms over time, although improvement may take consistent use.

Strength and Formulation

• Cyclosporine ophthalmic solution 0.09% w/v
• Preservative-free, single-use vials
• Each vial contains 0.25 mL of sterile, clear, colorless ophthalmic solution

Each vial is for single use only and should be discarded immediately after use, even if some solution remains.

How to Use CEQUA

CEQUA is for use in the eyes only.

• Wash your hands before using the vial.
• Open one single-use vial right before use.
• Instill one drop into each affected eye twice daily, about 12 hours apart.
• Do not allow the tip of the vial to touch your eye or any surface.
• Discard the vial immediately after use.

Do not use more than two drops per day in the affected eye or eyes.

Using CEQUA with Other Eye Drops

If you use other eye drops or artificial tears, wait at least 15 minutes between products. If you apply CEQUA first, wait 15 minutes before using any other eye product.

Contact Lenses

Do not use CEQUA while wearing contact lenses. If you wear contact lenses, remove them before applying the drops and wait at least 15 minutes before reinserting them.

Missed Dose

• If you miss a dose, skip it and continue with your next scheduled dose.
• Do not double your dose to make up for a missed one.

Common Side Effects

The most common side effect reported with CEQUA is pain when the drops are instilled. Other side effects may include:

• Eye pain or stinging
• Redness in or around the eye
• Eye irritation
• Swelling or redness along the eyelid margin
• Blurred vision after instillation
• Watery eyes
• A sensation that something is in the eye
• Eye discharge
• Headache
• Sore throat
• Increased sensitivity to light

Many reactions are mild and temporary, especially around the time the drops are applied.

Serious Side Effects and Warnings

Although CEQUA is generally well tolerated, there are important warnings to keep in mind.

Do Not Use if You Have an Eye Infection

CEQUA should not be used in patients with active or suspected ocular or peri-ocular infection. If an infection develops during treatment, CEQUA may need to be temporarily stopped until the infection is resolved.

Allergic Reactions

Serious allergic reactions have been reported, including:

• Face swelling
• Pharyngeal swelling
• Difficulty breathing
• Hives

If signs of an allergic reaction occur, stop CEQUA and seek medical care right away.

Blurred Vision After Use

Temporary blurred vision may occur after applying CEQUA. Patients should wait until their vision clears before driving or using machinery.

Long-Term Monitoring

Because CEQUA affects immune activity in the eye, regular eye monitoring is recommended during long-term use.

Who Should Not Use CEQUA

• Patients allergic to cyclosporine or any ingredient in the product
• Patients with active or suspected eye or peri-eye infections
• Patients with ocular or peri-ocular malignancies or premalignant conditions

Use in Special Populations

Pregnancy

There are no adequate data on the use of CEQUA in pregnant women. CEQUA is not recommended during pregnancy unless the benefits outweigh the risks.

Breastfeeding

It is not known whether CEQUA passes into human breast milk after topical eye use. Caution is advised when CEQUA is used during breastfeeding.

Pediatrics

CEQUA has not been established as safe or effective in children under 18 years of age.

Older Adults

No overall differences in safety or effectiveness were observed between older and younger adult patients.

Drug Interactions

No formal drug interaction studies have been performed with CEQUA. Because systemic absorption after eye use is very low, interactions with systemic medications are not expected to be significant.

Still, patients should tell their healthcare provider about all prescription drugs, over-the-counter medications, vitamins, and supplements they use.

Storage

• Store at room temperature between 15°C and 25°C.
• Do not freeze.
• Keep single-use vials in the original foil pouch until ready to use.
• Discard each vial after opening and use.
• Keep out of reach and sight of children.

How CEQUA Compares to Other Dry Eye Treatments

Dry eye treatment often includes lubricating eye drops, gels, ointments, lid hygiene, and prescription anti-inflammatory drops. CEQUA is a prescription option that targets ocular inflammation rather than simply lubricating the eye surface.

For patients with more significant or persistent dry eye, CEQUA may be used long term as part of a broader treatment plan. Artificial tears can still be used with CEQUA, as long as they are spaced apart by at least 15 minutes.

Buying CEQUA from Canada

Prescription dry eye treatments can become expensive when used long term, especially for patients paying out of pocket. Many Americans look to Canada to buy medications like CEQUA at a lower cost.

Over The Border Meds is a Canadian prescription referral service that helps eligible U.S. patients access medications from Canada with a valid prescription. For CEQUA, it is helpful to confirm your dosing schedule, how long you have been using it, and whether you are also using artificial tears or other ophthalmic products.

Learn more: Over The Border Meds

Disclaimer

This information is for educational purposes only and does not replace medical advice. Always use CEQUA exactly as prescribed by your healthcare provider and follow your eye specialist’s instructions regarding dry eye management.

Reference: CEQUA Product Monograph (Canada)

CEQUA is usually used as one drop in each affected eye two times a day, about 12 hours apart, or as directed by your prescriber. Before using it, wash your hands, remove contact lenses, and avoid touching the dropper tip to your eye or any surface. After placing the drop in the eye, close your eye gently for a few seconds so the medication can spread evenly. Using Cequa regularly as prescribed can help improve tear production and reduce dry eye symptoms over time.