Pregabalin Eye Drops for Dry Eye

Dry eye disease (DED) is usually thought of as an issue with moisture on the ocular surface, but in some patients, the homeostasis of their nervous system has been disrupted. This causes eye pain, including burning, stinging, or aching, and in some cases, this pain presents itself even when the ocular surface looks normal. This neuropathic pain stems from abnormal nerve activity rather than direct surface damage, and conventional treatments like lubricating drops don’t provide relief. 

In a previous blog post, we discussed how pregabalin eye drops can help manage ocular pain and also explored their potential for treating glaucoma. In this post, we’ll focus on pregabalin’s role in treating symptoms of dry eye and how compounding pharmacies can help make this therapy available to individual patients.

Using Pregabalin to Treat Dry Eye Pain

Pregabalin (sold under the brand name Lyrica®, available as an oral solution, tablet, or capsule only) is an oral medication for neuropathic pain such as diabetic neuropathy, spinal cord injury pain, and fibromyalgia. It works by binding to the α2δ subunit of voltage-gated calcium channels on neurons, which reduces the release of excitatory neurotransmitters and calms down hyperactive pain pathways.¹ This mechanism is relevant to dry eye patients with neuropathic pain, where the goal is to lessen eye pain that persists despite a healthy ocular surface.

Delivering pregabalin directly to the eye instead of as an oral capsule allows a highly localized concentration of the drug at corneal nerves while minimizing systemic circulation. This can help reduce systemic side effects such as dizziness that oral pregabalin may cause.¹ 

What Does the Research Say?

A small body of evidence supports the use of pregabalin for dry eye pain relief, including early murine studies and off-label clinical experience. A 2022 study in rats demonstrated that continuous pregabalin treatment significantly reduced dry eye-related ocular pain and even reversed some nerve changes.² In that chronic dry eye model, the rats developed neuropathic ocular pain after their lacrimal glands were removed. 

Standard tear-replacement therapy alone did not improve the pain, but adding pregabalin helped reduce pain by reducing corneal hypersensitivity and normalizing overactive neural activity. The investigators concluded that pregabalin was helpful in treating neuropathic ocular pain even after the chronic pain was established, suggesting it may play a role in helping treat neuropathic pain in dry eye disease.³

Clinical Studies of Pregabalin in the Eye

There are still limited human studies of pregabalin in the eye, but the early results are encouraging. A 2022 clinical trial in post-LASIK patients found that oral pregabalin (150 mg twice daily for 15 days) alleviated acute post-surgery eye pain.⁴ In that study, the pregabalin group reported significantly less ocular pain in the first week after LASIK compared to the control group. However, by six months after surgery, there were no significant differences between the pregabalin and control groups in terms of dry eye severity, corneal nerve density, or corneal sensitivity.

A 2023 systematic review of multiple trials reported that pregabalin significantly reduced acute ocular pain in the first 24–48 hours after eye surgeries compared to placebo, but it had no notable effect on chronic pain or dry eye symptoms months later.⁵ One of those trials did find pain relief lasting about a week post-op, suggesting that pregabalin’s main benefit is pain mitigation.

The American Academy of Ophthalmology has noted that gabapentin or pregabalin may be considered in dry eye patients with neuropathic pain features that don’t respond to normal treatments.⁶

Compounded Pregabalin Eye Drops

Despite its promise as an ophthalmic treatment, there are no commercial pregabalin eye drop products, and it is currently only available in oral formulations. A compounding pharmacy with sterile ophthalmic compounding capabilities is needed to reformulate pregabalin into sterile 0.6% eye drops. This requires specialized equipment and a sterile USP-compliant environment, as well as staff who has been trained in ophthalmic compounding. This includes in-depth knowledge of formulation techniques, such as whether the eye drops need a preservative, the drug’s stability in an appropriate vehicle, viscosity of the eye drops, and how to select a buffer to maintain an appropriate pH.⁷ 

Why Choose VLS Pharmacy & New Drug Loft?

Although the number of pharmacies engaging in ophthalmic compounding is on the decline, we remain committed. The compounding pharmacists at VLS Pharmacy specialize in this niche area of expertise, allowing us to continue to supply prescribers with ophthalmic preparations. By working closely with a 503A compounding pharmacy that specializes in ophthalmic compounding, providers can ensure that their pregabalin eye drops are precisely tailored to the specific needs of individual pediatric patients.

 

Please comment below with any thoughts or questions.

Reach out to our team to learn about best practices and to partner with our experts on custom compounded medications for your patients. All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.

 

References

1. Pregabalin. Accessed November 14, 2025. https://go.drugbank.com/drugs/DB00230
2. Tei Y, Mikami Y, Ito M, et al. Pathogenic Mechanism of Dry Eye–Induced Chronic Ocular Pain and a Mechanism-Based Therapeutic Approach. Invest Ophthalmol Vis Sci. 2022;63(1):7. doi:10.1167/iovs.63.1.7
3. Pregabalin could mitigate neuropathic symptoms of dry eye disease. American Academy of Ophthalmology. October 17, 2022. Accessed November 14, 2025. https://www.aao.org/education/editors-choice/pregabalin-could-mitigate-neuropathic-symptoms-of-
4. Paik DW, Lim DH, Chung TY. Effects of taking pregabalin (Lyrica) on the severity of dry eye, corneal sensitivity and pain after laser epithelial keratomileusis surgery. Br J Ophthalmol. 2022;106(4):474-479. doi:10.1136/bjophthalmol-2020-317570
5. Shen X, Chen X, He Y, Xu H, Zhu J. Efficacy and safety of pregabalin in eye pain: A systematic review. Medicine (Baltimore). 2023;102(6):e32875. doi:10.1097/MD.0000000000032875
6. Pain Without Stain: Managing Neuropathic Ocular Pain. American Academy of Ophthalmology. December 1, 2018. Accessed November 14, 2025. https://www.aao.org/eyenet/article/managing-neuropathic-ocular-pain
7. Hawkins B, ed. ASHP Guidelines on Pharmacy-Prepared Ophthalmic Products. In: Best Practices. American Society of Health-System Pharmacists; 2019:165-166. doi:10.37573/9781585286560.043

 

 

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