Tyrvaya is not a steroid. It belongs to a completely different drug class called cholinergic agonists, and it contains no steroid or corticosteroid ingredients. The active ingredient is varenicline tartrate, the same compound used in smoking cessation products but delivered here as a nasal spray at a much lower dose (0.03 mg per spray) to treat dry eye disease.
How Tyrvaya Actually Works
Rather than suppressing inflammation the way steroids do, Tyrvaya stimulates your body’s own tear production through a nerve pathway. The spray binds to receptors inside the nose that activate the trigeminal parasympathetic pathway, a signaling route that connects your nasal passages to your tear glands. This triggers increased production of all three components of the tear film: water, oil, and mucin. It’s a fundamentally different approach from both steroids and traditional eye drops.
The FDA approved Tyrvaya in October 2021 specifically for the signs and symptoms of dry eye disease. You spray it once in each nostril twice daily, about 12 hours apart. Because it’s a nasal spray rather than an eye drop, nothing goes directly into the eye.
Why the Distinction From Steroids Matters
Steroid eye drops are sometimes prescribed short-term for dry eye flares because they reduce inflammation quickly. But they come with real risks when used over longer periods. According to the American Academy of Ophthalmology, steroids can increase eye pressure and raise the risk of infection and cataracts with prolonged use. That means patients on steroid drops need regular monitoring of their eye pressure, and most doctors limit treatment to a few weeks.
Tyrvaya doesn’t carry those steroid-specific risks. It doesn’t affect eye pressure, and it’s not associated with cataract formation. For people who need ongoing dry eye management rather than a short-term flare fix, that safety profile is a meaningful difference.
What Side Effects to Expect Instead
Tyrvaya’s side effects are concentrated in the nose and throat, which makes sense given how it’s delivered. In clinical trials, sneezing was overwhelmingly the most common reaction, occurring in about 95% of patients using the approved dose. That number sounds alarming, but most people experience a brief sneezing episode right after spraying rather than prolonged discomfort.
Throat irritation affected roughly 14% of participants, and nose irritation affected about 8%. These are the kinds of side effects you’d associate with any nasal spray, not the systemic or ocular concerns that come with steroids.
Connection to the Smoking Cessation Drug
If varenicline sounds familiar, you may recognize it as the active ingredient in Chantix, the oral medication used to help people quit smoking. The nasal spray version in Tyrvaya uses the same compound but at a dramatically lower dose and delivered locally to the nose. Each spray contains just 0.03 mg of varenicline, compared to the 1 mg tablets used for smoking cessation. The goal here isn’t to affect nicotine cravings. It’s to activate the specific nerve receptors in the nasal passage that signal tear production.
How to Use Tyrvaya
Before first use, you’ll need to prime the bottle by pumping seven sprays into the air, away from your face. If you haven’t used it for more than five days, one additional priming spray gets it ready again. Don’t shake the bottle.
To take a dose, blow your nose if needed, then tilt your head back slightly. Insert the applicator into one nostril and angle the tip toward the top of your ear on that same side. Keep the tip away from the inner wall of your nose. Place your tongue against the roof of your mouth, breathe gently, and press the applicator once. Repeat in the other nostril. The whole process takes under a minute, and many people find it simpler than administering eye drops, particularly those who struggle with drop placement or eye sensitivity.