iKervis is the prescription drop everyone warns you stings. Here's honestly what it's for, what it feels like, how long it takes, what it costs, and the steroid-responder saga that led me to it in the first place.
Before I ever got to iKervis, I went through a couple of other prescription drops, and honestly, that journey is worth telling, because it shows how much dry eye is trial and error. So let me start at the beginning.
At my first full assessment with Dr Tam, he noticed I had papillae, little bumps under my eyelids, which can be a sign of an allergic reaction. He explained that at 28, it was unusual to be producing as few tears as I was, and he wondered if an allergic response might be part of what was suppressing them. So the first thing we tried was an anti-allergy drop (Catacrom) for a few weeks, to see if calming that down helped.
When I went back, the papillae had shrunk a little, but I wasn't producing any more tears, and I don't have itchy or watery allergy symptoms otherwise. So we ruled that out as a real driver of my dry eye. Worth trying, though, and that's the theme of this whole piece: you try things, and you see.
The next thing we tried was steroid eye drops. They calm inflammation quickly, and they're often used to settle the eye before starting a slow, stingy drop like iKervis. For me, though, this is where it got complicated: it turned out I'm a rare "steroid responder," and my eye pressure shot up, so I had to stop them straight away. That's a whole story of its own, and I've written about it, along with the gentler "soft" steroid I use now, in my piece on steroid eye drops and being a steroid responder.
iKervis is ciclosporin (0.1%). Ciclosporin is an immunosuppressant. The goal is to calm down an immune response in your eyes that's become overactive and is driving all that inflammation. Quiet the inflammation, and the hope is your eyes gradually start producing more of their own tears again. That's the whole idea.
You might see it called Restasis in the US. It's the same drug, ciclosporin, though Restasis is actually a lower strength (0.05%, twice a day) versus iKervis's 0.1% once at night. And the reason steroids often come before ciclosporin is partly to settle the eye first, because ciclosporin itself can be quite irritating, as I was about to find out.
iKervis comes in little single-use vials: one drop in each eye at night, then you throw the vial away. It feels wasteful, I know. I've been told, and I'll caveat heavily that I'm not a doctor and you should check with your own professional, that it can be okay to get a second drop out of the same vial in the morning, as long as you keep it scrupulously clean and don't let the tip touch anything. But that's between you and your clinician; the vials are labelled single-use for a reason.
Yes, it stings going in, and that's the thing everyone asks about. But honestly, for me that initial sting was fairly short-lived. The bigger problem was something else: I found iKervis tended to make my eyes burn more than usual right through the day, and it was that ongoing daytime discomfort, more than the sting itself, that became a big part of why I stopped.
I first tried iKervis a good while ago and didn't last very long on it, and I tried again more recently, about eight months ago now. It's genuinely hard to stick with, which matters, because...
Ciclosporin can take up to six months to make a real difference. So you're asked to persevere with a drop that makes your eyes uncomfortable, every night, for months, before you even know if it's working. I'll be honest: I've never quite managed to hold out long enough to find out. Managing that expectation upfront matters, because a lot of people give up thinking it's failed when really it just hadn't had time yet.
It's a genuine tightrope to walk. You're constantly weighing up the idea that if you just push through, you might finally start to see an improvement, against the reality of the drop making you uncomfortable right now, today. And when you're paying for it privately, and it isn't cheap, that pressure makes the decision even harder. There's no easy answer, and if you're wrestling with that trade-off, you have my full sympathy.
A few things genuinely helped me cope, in case they help you last longer on it than I first managed:
On a private prescription, iKervis was around £90 a month when I was paying for it (probably more now). That adds up fast.
Here's the genuinely useful bit, though. Mr Matheson has been brilliant at helping me get things on the NHS. He prescribed the iKervis, then wrote to my GP explaining that I needed it, and because of that, I was able to get it on an NHS prescription. Suddenly three months of iKervis cost me a single prescription charge (about £9.20) instead of £90 a month. I was so grateful.
It's the same lesson from my diagnosis story: a specialist's letter to your GP can completely change what you can access on the NHS. If you're paying privately for drops, it's well worth asking your specialist whether they'll write to your GP.
iKervis is a genuinely important drop for inflammatory, tear-deficient dry eye like mine, and the science behind it is sound. My one real problem with it is the discomfort it caused me: enough that I've never managed to stay on it long enough to get the full benefit. So my verdict is: worth trying, but go in knowing it stings and takes months, and lean on your specialist to get it funded.
The good news is that newer, gentler versions of ciclosporin have started to arrive, including an oil-based one that doesn't sting anything like as much, which for someone like me could be the difference between giving up and actually sticking with it. I've written up my first impressions of Vevizye, the water-free one that barely stings, if you want to read about it.
Does iKervis sting, and how long does the sting last?
Yes, it stings as it goes in, but for me that initial sting was fairly short-lived, a minute or so, and many people find it eases over the first few weeks. My bigger problem was a low-level burning through the day, which is what eventually made me stop. Keeping the vials in the fridge and using a lubricating drop a few minutes later genuinely helped.
Why does iKervis burn?
iKervis is ciclosporin, which can be irritating to the surface of the eye, especially early on while the eye is still inflamed. That's also why specialists often settle the eye with steroid drops before starting it. The burning tends to be worst at the beginning.
How long does iKervis take to work?
Ciclosporin can take up to six months to make a real difference. You have to use it every night through that whole period before you know if it's helping, which is exactly why so many people, me included, struggle to stick with it long enough.
Is iKervis the same as Restasis?
They're the same drug, ciclosporin, but different strengths. In the US it's usually Restasis at 0.05% twice a day; iKervis is 0.1% once at night. There's also a newer water-free version, Vevizye (Vevye in the US), which barely stings.
Can you get iKervis on the NHS?
Yes, though not directly from your GP. It's available on the NHS for severe dry eye that hasn't improved with artificial tears, but it has to be started by an eye specialist (an ophthalmologist, or someone qualified in ophthalmology). Once you're settled on it, they write to your GP so it can be prescribed on the NHS in primary care, which is exactly what happened for me. Availability can vary a little by area, so it's worth asking your specialist.
How much does iKervis cost, and can you get it on the NHS?
On a private prescription it was around £90 a month for me. The game-changer was my specialist writing to my GP, which got it onto an NHS prescription, so three months cost a single prescription charge (about £9.20) instead. If you're paying privately, it's well worth asking your specialist about that letter.
iKervis vs Vevizye, what's the difference?
Same active drug, different formulation. iKervis is water-based and stung enough that I kept giving up. Vevizye is water-free and barely stings, and it comes in a dropper bottle rather than single-use vials.
More of my journey: How I got diagnosed → · My IPL experience → · My punctal plugs → · My Vevizye first impressions →