Vyzulta is a prescription eye drop used to lower eye pressure in people with open-angle glaucoma or ocular hypertension. Its active ingredient, latanoprostene bunod, works through a dual mechanism that sets it apart from older glaucoma drops. The FDA approved it in November 2017, and it’s manufactured by Bausch + Lomb.
How Vyzulta Lowers Eye Pressure
Most traditional glaucoma drops lower intraocular pressure (IOP) by improving one of the two drainage pathways in the eye. Vyzulta targets both. Once the drop hits the surface of your eye, enzymes break it down into two active components. The first is latanoprost acid, the same compound found in the older glaucoma drug latanoprost. It increases fluid drainage through the secondary pathway at the back of the eye, called the uveoscleral outflow.
The second component releases nitric oxide, a signaling molecule that relaxes the tissue in the eye’s primary drainage channel, known as the trabecular meshwork. This widens the conventional outflow route, letting more fluid escape. By working on both pathways simultaneously, Vyzulta can produce greater pressure reduction than latanoprost alone. The VOYAGER trial confirmed that once-daily Vyzulta lowered IOP more than latanoprost at the same dosing schedule.
How to Use It
The standard dose is one drop in the affected eye once daily in the evening. Using it more than once a day won’t help and may actually reduce its effectiveness. If you wear contact lenses, remove them before applying the drop and wait at least 15 minutes before putting them back in. The solution contains a preservative called benzalkonium chloride, which can be absorbed by soft lenses.
Store an unopened bottle in the refrigerator (36°F to 46°F). Once you open it, you can keep it at room temperature, up to about 77°F, for up to 8 weeks.
Side Effects
Vyzulta’s side effect profile is similar to other prostaglandin-based eye drops. The most common reactions from clinical trials were eye redness (6% of patients), eye irritation (4%), eye pain (3%), and a stinging sensation at the application site (2%). These are generally mild and tend to settle with continued use.
Like all prostaglandin drops, Vyzulta can gradually change the color of your iris, darkening brown pigmentation over months or years. It may also cause your eyelashes to grow longer, thicker, or darker, and can darken the skin around the eyelid. These pigment changes may be permanent, and if you’re only treating one eye, the treated eye may eventually look different from the other.
Who Should Use Caution
Vyzulta is not a good fit for everyone. People with active inflammation inside the eye (iritis or uveitis) should generally avoid it, since prostaglandin drops can worsen inflammatory flares. If you have a history of eye inflammation but it’s currently quiet, your eye doctor may still prescribe it with closer monitoring.
Patients who’ve had cataract surgery with a complication involving the lens capsule, or those who’ve had their natural lens removed without a replacement, face a higher risk of macular edema (swelling in the central retina) with this class of drug. Vyzulta is also not recommended for children 16 and younger due to concerns about increased pigmentation from long-term use.
How It Compares to Other Glaucoma Drops
The two major phase 3 trials, called APOLLO and LUNAR, tested Vyzulta head-to-head against timolol, a beta-blocker eye drop that has been a standard treatment for decades. Vyzulta demonstrated IOP lowering that met the criteria to be considered at least as effective, and the VOYAGER study showed it outperformed latanoprost, the most widely prescribed prostaglandin drop worldwide.
That dual-mechanism advantage is the core reason Vyzulta exists. Standard prostaglandin drops only open the uveoscleral pathway. Beta-blockers like timolol reduce how much fluid the eye produces but don’t improve drainage. Vyzulta’s nitric oxide component adds a second drainage route to the prostaglandin effect, which can make a meaningful difference for patients whose pressure isn’t adequately controlled on a single-mechanism drop.
Cost
Vyzulta is a brand-name medication with no generic equivalent currently available. Without insurance or discount programs, a 2.5 mL bottle (roughly a one-month supply) averages about $315, while the 5 mL bottle runs around $606. Insurance coverage varies widely. Bausch + Lomb offers a savings program for eligible patients, and pharmacy discount cards can sometimes reduce the out-of-pocket price significantly. If cost is a barrier, generic latanoprost provides similar, though not identical, pressure-lowering for a fraction of the price.