IT’S ESTIMATED that nearly 30 million American adults have reported symptoms consistent with dry eye disease (DED), making this one of the most common ocular conditions. The question thus arises: What are you doing to treat these patients?


Last year, the FDA approved lifitegrast ophthalmic solution 5% (Xiidra, Shire) for the treatment of the signs and symptoms of DED. This b.i.d. eye drop works by inhibiting the binding of two molecules: ICAM-1, which is overexpressed in the tissues of those with DED, and LFA-1, an integrin receptor on the surface of T-cells. When ICAM-1 and LFA-1 bind together, they stimulate the recruitment and activation of T-cells and cytokine release, markers of inflammation in the ocular tissues. Xiidra binds to LFA-1, preventing this interaction, and, theoretically, preventing the inflammation associated with DED.

As we know, from both clinical experience and research, DED does not necessarily present in a clear clinical manner. Signs and symptoms can vary among patients, making treatment a confounding process. The mechanism of action for Xiidra addresses the underlying culprit in almost all types of DED — inflammation — making it applicable to virtually all DED patients in bringing them relief.


Before prescribing Xiidra, I instruct patients on proper use, and briefly discuss the success shown in the studies required for approval by the FDA.

In four clinical studies, a reduction in dryness — measured via an eye dryness score — was observed with Xiidra at six and 12 weeks. In two of the four studies, an improvement in dryness was seen with Xiidra at two weeks. At week 12, a rate reduction of inferior corneal staining score was observed in three of the four studies.

A patient script example: “This drop is for twice-daily usage, one drop in each eye, both morning and evening. Of all the studies used to approve Xiidra, most show that symptom relief was realized within weeks of starting, but every patient is different. I will be seeing you back in six to eight weeks for us to follow up on treatment outcome.”

In addition, prepare patients for possible adverse reactions, including instillation site irritation, altered taste sensation and reduced VA. This conversation sets the stage for appropriate expectations.


As I’ve grown my DED patient base, my clinic has enjoyed an increase of referrals due to patient satisfaction in treatment, especially because of Xiidra. Our Shire representative provided training on the product, helping our staff members to understand insurance coverage/co-pays and making sure both the clinic and patients have all the tools they need to be successful. Phone and online resources are also on hand for doctors and patients alike to access informational support, if necessary.


Remember, if an estimated 30 million Americans are reporting symptoms consistent with DED, it’s very likely these patients are in front of you every day in your practice. Offer them a new option for treatment, bring them relief, and excel at patient care with the newest technology in prescription eye care. OM