Miebo eye drops (perfluorohexyloctane) are a prescription treatment for dry eye disease, approved by the FDA in May 2023. The drop forms a thin layer where the tear film meets the air, which is expected to slow evaporation. We use it for eyes whose tears dry up too fast, as with meibomian gland dysfunction (MGD), a problem with the oil glands in the eyelids. In two studies of 1,217 people with dry eye and signs of MGD, damage on the eye's surface and dryness scores improved more with Miebo than with saline at day 15 and day 57. Blurred vision, the most common eye side effect, and eye redness were each reported by 1% to 3% of people, and contact lenses come out before each dose. Our page on prescription dry eye drops shows where it fits.
Key takeaways
- Miebo is a prescription dry eye drop that forms a film one molecule thick where the tears meet the air, which is expected to slow evaporation.
- Use it four times a day as the label directs, with contact lenses out before each dose and for at least 30 minutes afterward.
- In the main studies, blurred vision and eye redness were each reported by 1% to 3% of people, with blurred vision the most common eye side effect.
- An eye that becomes painful or keeps getting redder, or blurred vision that doesn't clear, needs a same-day exam, or an emergency room when we're closed.
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What are Miebo eye drops?
Miebo is the brand name for perfluorohexyloctane ophthalmic solution. It's a prescription drop, and its label covers the treatment of the signs and symptoms of dry eye disease.
The bottle holds a single ingredient. Miebo is a clear, colorless liquid made of 100% perfluorohexyloctane, a compound known as a semifluorinated alkane, so there is no water and no preservative in it.
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How does Miebo work?
Your tears have three layers: oil, water and mucus. The smooth outer oil layer helps keep the water layer from evaporating. Our page on the tear film shows how the layers work together.
Miebo acts at that outer surface. According to its label, perfluorohexyloctane forms a monolayer (a film one molecule thick) where the tear film meets the air, which can be expected to reduce evaporation. The label also says the exact way it works in dry eye isn't known.
Other prescription drops work on another part of the problem. Cyclosporine and lifitegrast drops can help your eyes make more tears, while Miebo is meant to keep the tears you already have from evaporating.
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Who is Miebo for?
Miebo is for people with dry eye disease, and in our office it's one of the options for evaporative dry eye, the type in which tears evaporate too fast. We use it together with treatment of the glands themselves. Our guide to types of dry eye explains how evaporative dry eye differs from the type in which the eyes make too few tears.
The studies behind its approval enrolled people with a history of dry eye and clinical signs of meibomian gland dysfunction. The meibomian glands are the oil glands in the eyelids, and when they get clogged, the inner edges of the lids can become inflamed, a type of blepharitis. Our page on meibomian gland dysfunction explains how we image these glands.
Its safety and effectiveness have not been established in people under 18.
If you're pregnant or breastfeeding, tell us before you start. There are no adequate and well-controlled studies of Miebo in pregnant women, and there are no data on whether perfluorohexyloctane passes into breast milk.
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How well does Miebo work?
Two randomized studies, called GOBI and MOJAVE, compared Miebo with saline in 1,217 people with dry eye and signs of meibomian gland dysfunction. The 614 people given Miebo used it four times a day for 57 days. Both studies were double-masked, meaning neither the patients nor the researchers knew who had which drop.
The researchers tracked two measures. Corneal staining uses a dye to show damaged spots on the cornea, the clear front of the eye, scored from 0 to 3 in each of five areas for a maximum of 15 per eye. Eye dryness was rated by the patients themselves on a scale from 0 (no discomfort) to 100 (maximal discomfort).
At day 15 and again at day 57, both scores improved more with Miebo than with saline in both studies. The differences were statistically significant, which means they were unlikely to be due to chance.
These are results for groups of patients, so they can't predict how much any one person will improve. We judge how well it's working for you by your symptoms and the surface of your eye at follow-up visits.
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How do you use Miebo?
Use it exactly as prescribed. The schedule on the label is four times a day.
The bottle takes a little practice. Following the label's steps, you remove the cap, hold the bottle upright and squeeze it gently, then keep squeezing as you turn it upside down and release the pressure so the bottle draws in air. Still holding it upside down above your eye, you squeeze again to release a drop.
- Take out contact lenses before each dose and leave them out for at least 30 minutes afterward.
- Once opened, the bottle can be used until the expiration date printed on it.
- If you use other eye drops too, ask us how to space them through the day.
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What are the side effects of Miebo?
In the two main studies, blurred vision was the most common eye side effect. Blurred vision and conjunctival redness (redness of the white of the eye) were each reported by 1% to 3% of people.
Don't use Miebo if you've had a hypersensitivity reaction (an allergic-type reaction) to perfluorohexyloctane. In four smaller studies done before the drug reached the market, hypersensitivity was the most common adverse reaction.
If your eye becomes painful or keeps getting redder, or your vision blurs and doesn't clear, call us right away for a same-day urgent eye care exam, or go to an emergency room when we're closed. Sudden loss of vision in one or both eyes, even if it comes back, is an emergency at any hour: call 911.
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How is Miebo different from other dry eye drops?
Prescription dry eye drops work in different ways, and we rarely rely on just one.
| Drop | What it does | Prescription needed? |
|---|---|---|
| Miebo (perfluorohexyloctane) | Forms a layer on the tear film that is expected to slow evaporation | Yes |
| Restasis (cyclosporine 0.05%) | Increases tear production when it is presumed to be suppressed by inflammation from dry eye | Yes |
| Xiidra (lifitegrast 5%) | Binds to LFA-1, a protein on white blood cells, and blocks a step that helps those cells become active | Yes |
| Artificial tears | Add lubrication; the most common treatment for mild dry eye | No |
Sources for the table: the Restasis label, the Xiidra label and the National Eye Institute's dry eye page.
When clogged oil glands are the cause, we often pair a drop like Miebo with in-office care aimed at the glands, such as IPL and gland expression.
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How we use Miebo at Cohenmehr Optometry
Our Los Angeles optometrists start by finding which part of the tear film is failing. A dry eye evaluation here checks how fast your tears break up between blinks, images the oil glands with meibography, measures tear volume and maps where the eye's surface stains.
When evaporation is the main problem, Miebo is one of the drops we consider. We match medication to your pattern of dryness, then monitor and adjust the plan, which often includes IPL, gland expression or lid care as well.
Bring every drop and medication you use to the visit, along with the names of treatments you've already tried.
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Questions patients ask
Do Miebo eye drops relieve dry eye pain?
Miebo's label doesn't report results for pain. The symptom it reports is eye dryness, which patients rated on a scale from 0 (no discomfort) to 100 (maximal discomfort), and those scores improved more with Miebo than with saline at day 15 and day 57. Stinging and burning are common dry eye symptoms, but new or severe eye pain needs a same-day urgent eye care exam, or an emergency room when we're closed.
Can you use eye drops for dry eyes with contacts?
Prescription dry eye drops generally go in with your lenses out. Miebo's label says to remove contact lenses before each dose and wait at least 30 minutes before putting them back in, and the Restasis and Xiidra labels say 15 minutes. For any drop you'd use with lenses in, ask us first; the FDA advises using contact lens products and solutions recommended by your eye care professional. If dryness makes your lenses uncomfortable, see our page on contact lens discomfort.
Can rosacea cause dry eyes?
Yes. Rosacea is a skin condition that causes redness and bumps, usually on the face, and it can also cause eye problems: with ocular rosacea, the eyes may become sore, red, itchy, watery or dry. Rosacea can also cause blepharitis along the inner edge of the eyelids, where the oil glands can clog. That oil-gland side of dry eye is where a drop like Miebo can be part of the plan; our ocular rosacea page explains how we treat it.
Where can I get dry eye treatment in Los Angeles?
At Cohenmehr Optometry, 12222 Wilshire Blvd in West Los Angeles, on the Santa Monica border. Dr. Bijan Cohenmehr leads dry eye care here. An evaluation looks at how stable your tears are, images the oil glands with meibography and checks the surface of the eye. Treatment can include IPL, OptiLIFT, punctal plugs, prescription drops such as Miebo and scleral lenses. You can book through our dry eye treatment page or call 310-828-2010.
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Sources
- FDA: Novel drug approvals for 2023
- DailyMed: Miebo prescribing information
- American Optometric Association: Dry eye
- National Eye Institute: Dry eye
- National Eye Institute: Blepharitis
- DailyMed: Restasis prescribing information
- DailyMed: Xiidra prescribing information
- FDA: Contact lens solutions and products
- American Stroke Association: Stroke symptoms
- NIAMS: Rosacea
Written by
Dr. Bijan Cohenmehr, OD
Founder of Cohenmehr Optometry, in practice for over 40 years. He leads the practice’s dry eye care and myopia management. A graduate of SUNY College of Optometry.
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