Dry eye disrupts the eye’s tear production system, affecting the moisture of the eye’s surface. A nasal spray can help improve tear production and treat symptoms of the condition.

Dry eye is a common condition affecting millions of people in the United States each year. The condition is more than just uncomfortable. If left untreated, it can sometimes cause damage to the structure of the eye, which in turn affects vision.

Treating dry eye with medications typically involves the use of eye drops. However, a nasal spray option has recently become available. Read on to learn more about how nasal sprays work to treat dry eye and considerations for their use.

Multiple clinical trials have investigated nasal spray treatment for dry eye. These studies have included adults with dry eye who are at least 22 years of age.

In the ONSET-1 clinical trial, people with dry eye disease who received twice-daily medicated nasal spray had greater tear production and fewer symptoms of dry eye than those who received a nonmedicated nasal spray after 28 days of treatment.

Similar results were observed in the phase 3 ONSET-2 clinical trial, which included a larger group of participants (758 people) compared to the ONSET-1 trial (182 people).

The MYSTIC clinical trial also found that using a medicated nasal spray improved tear production in people with dry eye versus a nonmedicated nasal spray over a longer treatment period (12 weeks).

A combined analysis of the ONSET-1 and -2 studies found that medicated nasal spray helps improve symptoms of dry eye regardless of the severity of symptoms at the start of treatment.

The only medication currently approved for use as a nasal spray to treat dry eye is varenicline solution (Tyrvaya).

Varenicline is a small molecule that binds to receptors within sensory nerves. As a nasal spray, it stimulates the nerve endings in the nasal cavity to trigger tear production. Researchers used the varenicline solution nasal spray in the ONSET-1, ONSET-2, and MYSTIC clinical trials.

The dosage for Tyrvaya is 1 spray in each nostril twice daily.

Researchers have also studied another medication — simpinicline solution — as a potential nasal spray treatment for dry eye. Simpinicline works similarly to varenicline to promote tear production via stimulation of sensory nerves in the nose. In a 2022 clinical trial, people who received a single dose of simpinicline-containing nasal spray had increased tear production and improvement in dry eye symptoms within minutes.

However, nasal spray simpinicline solution is not currently approved to treat dry eye.

Tyrvaya nasal spray aims to work quickly.

The ONSET-1 clinical trial involved exposing participants to harsh conditions that can trigger dry eye symptoms, such as dry air, high winds, and harsh lighting. In these environments, increased tear production occurred within 5 minutes of taking Tyrvaya. For some people, it even worked as quickly as within 10–30 seconds of receiving the nasal spray.

Researchers noted consistent improvement in dry eye symptoms after 4 weeks of continuous, daily use.

Clinical trials note sneezing as the most common side effect of Tyrvaya nasal spray. Other common side effects may include:

  • coughing
  • throat irritation
  • nasal irritation

Most side effects linked with Tyrvaya nasal spray are mild and typically improve on their own. In clinical trials, most people did not have to stop treatment with Tyrvaya due to side effects.

In very rare cases, some vision changes can occur with Tyrvaya nasal spray.

Tyrvaya nasal spray can help increase tear production and reduce symptoms in people with dry eye. This medication begins working quickly and can provide sustained improvements in dry eye symptoms with regular use. Side effects of Tyrvaya are usually mild and typically resolve on their own.

Adults with dry eye who wish to try Tyrvaya can talk with an ophthalmologist to learn more about nasal spray treatment to help manage dry eye symptoms.