Sight Sciences (SGHT) Q1 2026 earnings review
Growth Reverses Course, Led by Reimbursed Dry Eye Explosion
Sight Sciences has officially broken out of its 2025 slump. Total revenue accelerated to 13% YoY growth in 26Q1, marking a stark reversal from the negative prints seen in early 2025 following Medicare Local Coverage Determination (LCD) restrictions. The turnaround is driven by the Interventional Dry Eye (IDE) segment, which surged 244% YoY as the company finally monetizes TearCare under new Medicare Administrative Contractor (MAC) fee schedules. The core Interventional Glaucoma segment also stabilized with 7% growth. A massive $55.4M patent litigation win against Alcon adds to the bullish narrative, though it remains subject to appeal. Management subsequently raised FY26 revenue guidance.
🐂 Bull Case
The strategic pivot to focus on reimbursed TearCare procedures is paying massive dividends. IDE revenue nearly doubled sequentially from 25Q4, proving the MAC fee schedules established in late 2025 are translating directly to top-line acceleration.
Despite investing in commercial expansion, Q1 cash usage dropped 40% YoY to just $7.0M. Adjusted operating expenses fell 14%. With $85M on the balance sheet, the company's path to cash flow breakeven looks highly credible.
🐻 Bear Case
While Interventional Glaucoma grew 7%, it was driven entirely by higher average selling prices and new accounts. Actual per-account utilization declined, suggesting underlying procedure volume growth remains challenged.
The $55.4M past damages and 10% royalty from Alcon represent a massive potential cash injection. However, the verdict is subject to appeal, while Sight Sciences has already had to absorb a $5.4M success fee in Q1 OpEx.
⚖️ Verdict: 🟢
Bullish. The company is successfully navigating past the restrictive 2025 MIGS reimbursement changes. The explosive, profitable growth of the Dry Eye segment and disciplined cost control make the raised guidance highly believable.
Key Themes
Interventional Dry Eye Erupts on Reimbursement Wins
TearCare is no longer a 'show me' story—it's executing. Interventional Dry Eye revenue hit $1.4M in Q1, accelerating 244% YoY and 87% sequentially. The segment's gross margin expanded to 72% (up from 42% in early 2024), driven by higher average selling prices under the new reimbursed model. The sale of 1,534 lid treatment units in Q1 indicates aggressive provider uptake following the Novitas and First Coast MAC fee schedules.
Operational Discipline Drives Financial Stability
Management continues to structurally lower the company's cost base. Adjusted operating expenses were $21.2M, a 14% YoY deceleration. This drop is the direct result of late-2025 structural reductions in force. Consequently, quarterly cash burn compressed to just $7.0M, down from $11.6M a year ago, extending the company's runway significantly.
OMNI Edge Innovation Supports ASPs
The rollout of the OMNI Edge Surgical System with TruSync technology is actively supporting higher average selling prices (ASPs). The premium pricing of this next-generation technology offset utilization volume weakness, keeping the Glaucoma segment in positive growth territory.
Litigation Success Brings Upfront Costs
The Alcon patent infringement victory ($55.4M past damages + 10% royalty on Hydrus) is a massive fundamental win. However, because it is subject to appeal, the cash is not yet secured. Conversely, the victory triggered an immediate $5.4M one-time success fee in Q1 SG&A, artificially inflating GAAP net loss in the current quarter.
Glaucoma Account Utilization Paradox
A clear contradiction exists in the Glaucoma narrative: Revenue grew 7% to $18.3M, but management explicitly noted that 'utilization per account' was lower. The growth was salvaged entirely by an increase in the number of ordering accounts (up to 1,175) and higher ASPs. If per-account volume continues to decelerate, ASP increases alone will not sustain long-term segment growth.
Macro: Tariff Pressures Persist in COGS
Interventional Glaucoma gross margins remained flat at 87% YoY. Management noted that higher ASPs and favorable product mix were actively offset by increased tariff expenses. With production still heavily tied to China, these 30%+ tariffs remain a structural headwind on unit economics until the company completes its supply chain diversification.
Other KPIs
Stable. Total gross margin was perfectly flat YoY at 86.2%. The structural improvement in Dry Eye margins (up to 72.1% from 70.6%) was offset by the increased weight of tariff expenses in the Glaucoma segment.
Down sequentially from $92.0M at the end of 2025. With a reduced quarterly cash burn of $7.0M and long-term debt steady at $40.0M, the company has an implied runway of over 3 years, validating management's claim that they will not need to raise additional equity capital.
Guidance
Accelerating. Management raised the full-year target from the prior $82.0-$88.0M range. The midpoint ($86.0M) implies 11% YoY growth compared to 2025's $77.4M. This indicates confidence that Q1's double-digit growth is structural, not a one-off.
Accelerating wildly. Raised from a prior $5.0-$7.0M outlook, and a massive leap from the $1.6M achieved in full-year 2025. Q1 alone delivered $1.4M, meaning the company expects to average nearly $2M per quarter for the rest of the year as new MAC regions scale.
Stable. Unchanged from prior guidance. The midpoint ($79.0M) implies roughly 4% YoY growth, relying on standalone pseudophakic adoption to offset the lingering effects of combo-cataract MIGS restrictions.
Stable. Reaffirmed. This represents a 6% to 9% increase over 2025, driven by targeted investments in commercial sales forces to attack the newly reimbursed dry eye market and the standalone glaucoma opportunity.
Key Questions
Alcon Litigation Timeline
With the final judgment on post-trial motions issued for the $55.4M award and 10% royalty, what is your realistic timeline for the appeals process, and how will legal expenses trend while we wait for final resolution?
Glaucoma Utilization Dynamics
You noted that Glaucoma revenue growth was supported by new ordering accounts and higher ASPs, but utilization per account dropped. What is driving this lower per-account utilization, and when do you expect it to bottom out?
Commercial Payer Expansion for TearCare
Now that you have established fee schedules with two MACs and delivered $1.4M in Q1 Dry Eye revenue, what specific feedback are you getting from commercial payers regarding broader coverage expansions in the remainder of 2026?