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INFLAMMATION IS AN UNDERLYING CAUSE OF DRY EYE4
Stress to the ocular surface can cause an overexpression of inflammatory mediators, like ICAM-1. ICAM-1 binds to LFA-1, a cell surface protein found on T cells5,6
This interaction can lead to activation of T cells at multiple sites, migration of T cells to the ocular surface, and release of proinflammatory cytokines, triggering a vicious cycle of inflammation, which can lead to chronic tissue damage3,5,6
Up to 65% of patients with dry eye disease may have clinically significant ocular surface inflammation7
COMMON SYMPTOMS2,8
Patients living with dry eye disease may experience the following:
Redness
Burning
Irritation
Ocular pain
Visual
fluctuation
Foreign body sensation
Symptoms such as ocular discomfort and signs such as conjunctival hyperemia, corneal and conjunctival staining, tear hyperosmolarity, and a positive MMP-9 test may indicate the presence of ocular surface inflammation3,9
Contributing Factors9
- Hormone imbalances (eg, menopausal age group)
- Prolonged contact lens use
- Underlying inflammatory conditions
- Autoimmune conditions (eg, Sjögren’s syndrome, rheumatoid arthritis)
- History of diabetes
- Ophthalmic surgery
Symptoms and risk factors of dry eye disease are not limited to those listed above.
Identifying Inflammation
The following scenarios represent real, ECP-provided case studies of patients who are experiencing dry eye with inflammation.
Clinical findings
-
- Fluorescein staining: Moderate punctate epithelial erosions on cornea
- Corneal topography: Altered corneal curvature
Slit-lamp examination
-
- Mild to moderate conjunctival hyperemia OS
- Mild to moderate conjunctival staining
- Reduced TBUT
- No significant MGD
Background and medical history
- Wears disposable CLs
- Recently reduced CL wear time
- Mild seasonal allergies
Current symptoms and treatments
- Persistent ocular discomfort and EOD dryness
- Foreign body sensation
Current symptoms and treatments
- Intermittent blurred vision and visual disturbance
- Regular and preservative-free AT
Potential treatment goals
Reduced EOD eye
dryness and discomfort-
Reduced dry
eye symptoms -
Improved comfortable
CL wear time
CLs, contact lenses; MGD, meibomian gland dysfunction; OS, left eye; TBUT, tear breakup time.
Clinical findings
-
- Refraction: Soft 20/20 OU in phoropter
- Corneal staining: Mild/moderate
- TBUT: 2-3 seconds
Slit-lamp examination
-
- Lashes: clear OU
- Lids: MGD – turbid gland expression OU
- Mild conjunctival hyperemia
- Punctate epithelial erosions on cornea
Background and medical history
- Postmenopausal
- Wears glasses
- Hypercholesterolemia, use of simvastatin
Current symptoms and treatments
- Mild redness OU
- Blurry vision at distance
Current symptoms and treatments
- Eye fatigue, burning, and watering
- Occasional use of ATs
Potential treatment goals
-
Improve fluctuating
vision and burning -
Reduce corneal staining,
dryness, and foreign body
sensation -
Increase ocular comfort
with prolonged reading
and screen use
MGD, meibomian gland dysfunction; OU, both eyes; TBUT, tear breakup time.
Clinical findings
- Refractive errors; presbyopia and mild myopia
- SPEED score: 8
- Osmolarity: 310/325 mOsm
- InflammaDry: pos/pos
- Meibography: grade 2+ with inspissated discharge
- NaFl staining: 1+/3+ centrally
Background and medical history
- Scheduled for cataract surgery, multifocal IOLs
- Wears reading glasses for near-vision activities
Current symptoms and treatments
- History of refractive errors
- Pre-op assessment revealed DED
Current symptoms and treatments
- Mild eye dryness in the evening; frequent tired eye or vision fluctuation
- Difficulty adjusting to different light levels, driving, watching television
- Uses ATs regularly
Potential treatment goals
-
Improvement in ocular
surface health -
Reduced corneal

staining -
Improved biometry
accuracy
DED, dry eye disease; NaFl, sodium fluorescein; SPEED, Standardized Patient Evaluation of Eye Dryness.
Clinical findings
Slit-lamp examination
- Cornea staining: Grade 1+ in interpalpebral and central zones
- Conjunctival injection: Grade 2+
- TBUT: Reduced (8s): tear film instability
Slit-lamp examination
- SPEED score: 6
- Meibomian gland inspissation without scurf: Trace to 1+
- Tear osmolarity scores: 324 and 339 mOsm/L
Background and medical history
- No significant medical history of dry eye or related conditions other than mild and well-controlled hypertension
Current symptoms and treatments
- Redness and fluctuating vision that is worse toward the end of the workday
- Gritty and tired eyes
Current symptoms and treatments
- Complaints of burning and itchy eyes, especially after a day of computer use at work
- Has been using various ATs for the past few months with temporary and limited relief
Potential treatment goals
-
Symptom improvement
in 2 weeks -
Sign improvement -
Reduced AT use
SPEED, Standardized Patient Evaluation of Eye Dryness; TBUT, tear breakup time.
Clinical findings
-
- Visual acuity: 20/40 OU
- InflammaDry test: positive for elevated MMP-9
Slit-lamp examination
-
- Moderate conjunctival hyperemia
- Fluorescein staining: diffuse staining
Background and medical history
- Chronic eye discomfort for several years
- Occasional joint stiffness and fatigue, but no recent RA flares
Current symptoms and treatments
- Complaints of gritty sensation, redness, burning, and eye pain
- Visual fluctuations and chronic discomfort in both eyes
Current symptoms and treatments
- Uses ATs every 2-3 hours without relief
- Currently on disease-modifying therapy methotrexate and low-dose corticosteroids for RA
Potential treatment goals
-
Improvement in
symptoms of dry eye -
Decrease in visual
fluctuation -
Better tolerance for
prolonged visual task
OU, both eyes; QID, 4 times a day; RA, rheumatoid arthritis.
Patient portrayals. Images edited or rendered by AI.
How Xiidra Works
Xiidra addresses T cells differently to defend against dry eye inflammation6
ATs, artificial tears; EOD, end-of-day; ICAM-1, intercellular adhesion molecule 1; IOLs, intraocular lenses;
LFA-1, lymphocyte function-associated antigen 1; MMP-9, matrix metalloproteinase-9.
The exact mechanism of action of Xiidra in dry eye disease is not known.
Indication and important safety information
Indication
Xiidra® (lifitegrast ophthalmic solution) 5% is indicated for the treatment of signs and symptoms of dry eye disease (DED).
Important Safety Information
- Xiidra is contraindicated in patients with known hypersensitivity to lifitegrast or to any of the other ingredients.
- In clinical trials, the most common adverse reactions reported in 5-25% of patients were instillation site irritation, dysgeusia and reduced visual acuity. Other adverse reactions reported in 1% to 5% of the patients were blurred vision, conjunctival hyperemia, eye irritation, headache, increased lacrimation, eye discharge, eye discomfort, eye pruritus and sinusitis.
- To avoid the potential for eye injury or contamination of the solution, patients should not touch the tip of the single-use container to their eye or to any surface.
- Contact lenses should be removed prior to the administration of Xiidra and may be reinserted 15 minutes following administration.
- Safety and efficacy in pediatric patients below the age of 17 years have not been established.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Click here for full Prescribing Information for Xiidra.
References
- Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017;15(3):276-283. doi:10.1016/j.jtos.2017.05.008
- American Academy of Ophthalmology. Dry Eye Syndrome Preferred Practice Pattern®. Accessed April 14, 2025. https://www.aaojournal.org/action/showPdf?pii=S0161-6420(18)32650-2
- Data on file. Bausch & Lomb Inc.
- Bron AJ, de Paiva CS, Chauhan SK, et al. TFOS DEWS II pathophysiology report. Ocul Surf. 2017;15(3):438-510. doi:10.1016/j.jtos.2017.05.011
- Pflugfelder SC, Stern M, Zhang S, Shojaei A. LFA-1/ICAM-1 interaction as a therapeutic target in dry eye disease. J Ocul Pharmacol Ther. 2017;33(1):5-12. doi:10.1089/jop.2016.0105
- Donnenfeld ED, Perry HD, Nattis AS, Rosenberg ED. Lifitegrast for the treatment of dry eye disease in adults. Expert Opin Pharmacother. 2017;18(14):1517-1524. doi:10.1080/14656566.2017.1372748
- Sambursky R. Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye. Clin Ophthalmol. 2016;10:2337-2343. doi:10.2147/OPTH.S121256
- Sullivan DA, Rocha EM, Aragona P, et al. TFOS DEWS II sex, gender, and hormones report. Ocul Surf. 2017;15(3):284-333. doi:10.1016/j.jtos.2017.04.001
- Market Scope. 2023 Dry Eye Products Market Report: Global Analysis for 2022 to 2028. Market Scope®, LLC; 2023. Accessed April 14, 2025. https://www.market-scope.com/pages/reports/411/2023-dry-eye-products-market-report-global-analysis-for-2022-to-2028-november-2023
Indication and important safety information
Indication
Xiidra® (lifitegrast ophthalmic solution) 5% is indicated for the treatment of signs and symptoms of dry eye disease (DED).
Important Safety Information
- Xiidra is contraindicated in patients with known hypersensitivity to lifitegrast or to any of the other ingredients.
- In clinical trials, the most common adverse reactions reported in 5-25% of patients were instillation site irritation, dysgeusia and reduced