Glaukos (GKOS) Q3 2026 earnings review
Glaukos revenue jumps 58% as its new corneal drug surges
Glaukos's new corneal therapy took off in its first quarter with a permanent billing code, pushing the eye-care company into a profit. Revenue rose 58% from a year ago as Epioxa sales nearly quintupled from the second quarter, lifting cash by $51 million. Chief executive Thomas Burns raised the 2026 sales plan and introduced a $1 billion target for 2027.
| Revenue | $211.0M +58% from a year ago |
|---|---|
| Epioxa corneal drug sales | ~$53M ~$11M last quarter |
| Profit per share, excluding one-offs | $0.47 -$0.16 a year ago |
| Full-year 2026 revenue outlook | Raised $90M 2027 plan set at $1B |
⚖️ Verdict: 🟢🟢 Very Bullish
The story got much better because Epioxa bypassed the billing slowdown management had warned about and proved it can carry growth alongside iDose TR. That jump also ended years of operating losses and cash burn. One caution: iDose TR added only $2 million from last quarter, and five regional Medicare contractors still have proposed coverage limits pending.
The question now is whether iDose TR resumes double-digit sequential growth or stalls near its current level under Medicare coverage pressure. If iDose re-accelerates, the $1 billion 2027 target looks cautious; if regional Medicare rules restrict its use, Epioxa must carry the 2027 plan alone. Fourth-quarter iDose sales and the final Medicare coverage decisions will decide it.
🐂 Bull Case
Epioxa Revenue Nearly Quintupled Without the Feared Reset
Epioxa is Glaukos's incision-free drug therapy for keratoconus, a blinding corneal condition. Last quarter, the eye-care company warned of a temporary slowdown as doctors switched to a permanent billing code on July 1. Instead, the product's sales nearly quintupled from the second quarter, and the raised full-year outlook confirms the billing transition is working.
- Epioxa revenue: about $53 million, up from $11 million last quarter
- Corneal Health segment revenue: $59.0 million, up 154% from a year ago
- U.S. population covered by deployed treatment systems: roughly 90%, up from 85% last quarter
- Commercial insurance coverage: pathways established for about 90% of U.S. commercial lives and over 80% of Medicaid lives
The company reported "encouraging progress during the third quarter in optimizing the operational processes supporting reporting and reimbursement". Because Epioxa carries a much higher price per eye than the older Photrexa therapy it replaces, converting even a small share of covered patients lifted segment revenue above what the prior outlook implied for the entire second half.
What to watch: Fourth-quarter Epioxa sales in the next release. Another sequential gain will show that third-quarter shipments reflected ongoing patient treatments rather than initial clinic stocking.
Operating Leverage Turned Profit and Cash Flow Positive
Rapid sales growth from high-margin eye therapies pushed the business into profitability and generated $50.5 million in new cash during the third quarter. Gross margin excluding one-offs rose 3.8 percentage points from a year ago to 87.7%, while operating expenses shrank relative to sales and actually fell 3% from the second quarter.
- Selling, general and administrative cost (sales and overhead) excluding one-offs: 52.0% of revenue, down 10.3 percentage points from a year ago
- Research and development cost: 22.8% of revenue, down 5.7 percentage points from a year ago
- Operating income: $0.8 million ($27.3 million excluding one-offs, a 12.9% margin)
- Cash and short-term investments: $339.8 million, up from $289.3 million in Q2 with no debt
Reported selling and overhead expenses included $20.0 million in one-time legal costs, mainly $14.1 million for a settlement with the University of California. Even with those charges, Glaukos earned a reported net profit of $2.0 million because revenue grew nearly twice as fast as core operating costs.
What to watch: Operating expenses in the fourth quarter. Holding quarterly core spending near $158 million while revenue rises toward the implied $233 million fourth-quarter level will confirm sustained profit margins.
Full-Year Plan Raised $90 Million With $1 Billion Set for 2027
Chief executive Thomas Burns raised the 2026 revenue outlook to $775–785 million, up $90 million at the middle of the range from the plan set three months ago. Management also introduced a preliminary 2027 revenue forecast of $1 billion, which points to 28% growth next year by our math.
This is the third raise to the 2026 outlook, and each increase has been larger than the one before: $17.5 million in Q1, $62.5 million in Q2, and $90.0 million in Q3. By our math, the new 2026 midpoint leaves $232.8 million for the fourth quarter, or 62.7% growth from a year ago. That shows the third-quarter surge is carrying into year-end.
What to watch: The formal 2027 revenue range and product breakdown on the fourth-quarter call. Setting the initial range at or above $1 billion will show whether both new drugs are contributing to next year's growth.
🐻 Bear Case
iDose Sequential Growth Slowed While Medicare Rules Hang Over 2027
Burns highlighted "two transformational growth drivers in iDose TR and Epioxa". iDose TR is a tiny implant placed inside the eye to deliver glaucoma medication for up to three years, and management has expanded trained surgeons, payer coverage, and Phase 4 clinical data. However, iDose TR accounted for almost none of the company's sequential revenue jump this quarter.
U.S. iDose TR sales reached approximately $76 million, up 90% from a year ago but up only $2 million from the second quarter's $74 million after a $20 million jump the quarter before. Total U.S. Glaucoma sales were $118.6 million versus $118.5 million in Q2. Meanwhile, Glaukos still lists "Uncertainties associated with five MAC’s proposed LCDs for iDose TR"—regional Medicare coverage rules that could require patients to try eye drops or laser therapy first.
What to watch: Final local coverage determinations from the five Medicare contractors and fourth-quarter iDose TR sales. If sequential growth stays near $2 million or final rules restrict first-line use, Epioxa will have to carry the $1 billion 2027 target.
International Glaucoma Sales Shrank From Last Quarter on Stent Rivals
Outside the United States, Glaukos sells Micro-Invasive Glaucoma Surgery (MIGS) stents, which are tiny implants used to relieve eye pressure, often during cataract surgery. While the company is building its overseas sales force ahead of future product approvals, international growth has slowed for two straight quarters.
International Glaucoma sales were $33.4 million in the third quarter, down 8.9% from $36.6 million in the second quarter. Growth from a year ago slowed to 13.3% (14.6% in constant currency), down from 17.2% in Q2 and 23.4% in Q1. In its outlook notes, the company pointed to "Combo-cataract MIGS competition globally" as an ongoing headwind.
What to watch: Fourth-quarter International Glaucoma revenue growth in constant currency. A drop into single digits would show rival stents are taking market share before iDose TR and Epioxa launch overseas.
👓 Other Themes
Domestic Manufacturing Shields Margins From Trade Tariffs
Addressing global trade tensions, Glaukos reiterated that it produces and sources its therapies mainly inside the United States. The company stated that it continues to "expect minimal direct exposure to the most recently implemented tariff-related policies", while noting it will monitor broader economic and currency shifts that affect its international sales.
💲 Other KPIs
Accounts receivable—money owed by customers for delivered products—rose 52.0% from a year ago and 8.0% from the second quarter. That trails the 58.0% jump in third-quarter revenue and 13.7% sequential sales growth, showing that clinics and specialty pharmacies are paying on time as Epioxa billing scales up.
Diluted shares rose 6.6% from a year ago and 4.0% from the second quarter. Because the medical technology group earned a reported profit in the third quarter, accounting rules added 2.1 million employee stock options and restricted stock awards into the diluted share count, whereas prior loss-making quarters excluded them.
Spending on property and equipment equaled 1.0% of revenue by our math, down from $2.7 million in the second quarter and $4.0 million in the first quarter. Management noted that capital spending reflected routine maintenance and equipment upgrades.
🔮 Guidance
Raised. The middle of the range moved up $90 million to $780 million, or 53.7% growth for the year by our math. By our math, that leaves $232.8 million for the fourth quarter, up 62.7% from a year ago and 10.3% from the third quarter. It is the third raise this year, and each step has grown larger: +$17.5M, +$62.5M, and +$90.0M.
New. The ophthalmic group issued its first revenue target for 2027 at $1 billion. By our math, that represents 28.2% growth over the raised 2026 outlook midpoint, adding $220 million in annual sales as Epioxa and iDose TR expand across U.S. clinics.
❓ Key Questions
Did clinic stocking boost third-quarter Epioxa sales?
Epioxa revenue jumped from $11 million in Q2 to $53 million in Q3 right as the permanent billing code took effect on July 1. Investors need to know how many eyes were actually treated versus how much inventory clinics ordered ahead of treatments.
Why did iDose TR add only $2 million from Q2?
After growing by $20 million in the second quarter, U.S. iDose TR sales moved from $74 million to $76 million in Q3. Management did not say whether summer surgery schedules or caution around the five proposed Medicare coverage rules slowed the pace.
What are the payment terms for the RevOpsis retinal deal?
In October, Glaukos signed an "exclusive license agreement with RevOpsis Therapeutics for RO-104" and up to four additional retinal drugs. The release did not disclose the upfront cash payment or milestone commitments that will hit fourth-quarter expenses.
When will Glaukos release data from the GLK-401 retinal trial?
The company finished enrolling patients in its first human trial for GLK-401 in wet age-related macular degeneration during the fourth quarter of 2025. Three quarters later, the pipeline update still lists enrollment completion with no clinical results.