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  • Comprehensive Ophthalmology, Cornea/External Disease

    Lifitegrast (Xiidra) is the newest FDA-approved prescription therapy for dry eye. With advertising featuring actress Jennifer Aniston and a Super Bowl commercial aired last Sunday, your patients may be asking you about it soon. 

    In clinical trials, it was found effective in reducing symptoms of dryness and improving inferior corneal staining. However, real-world behavior is not yet fully established. 

    Lifitegrast is an anti-inflammatory drug that inhibits an integrin, lymphocyte function-associated antigen 1 (LFA-1), from binding to intercellular adhesion molecule 1 (ICAM-1). This inhibition leads to the down-regulation of T lymphocytes mediated inflammation. 

    It is encouraging that new treatments are being approved for a common disease that affects the quality of life of millions of Americans. 

    Dry eye is a diagnosis that incorporates a wide variety of clinical findings. How the disease is treated is based on an understanding of its underlying pathophysiology. 

    Dry eye clinical findings include sensations of ocular dryness and ocular surface disturbances. Beyond dryness, other symptoms include fluctuating and/or blurry vision, ocular dysesthesias described as “burning”, “tender” and “aching”, and tearing. 

    It can present with a variety of ocular surface abnormalities, including fast tear film breakup time, low Schirmer score, meibomian gland abnormalities, ocular surface disruption, high tear osmolality, and/or ocular surface inflammation. 

    In some patients, the severity of dry eye signs match their symptoms, but in others there is a discordance between the two. As such, it is apparent that dry eye is a complex, multi-factorial disease that can be grouped into various sub-types. 

    For example, the presentation and underlying pathophysiology of Sjogrens syndrome and graft-versus-host associated dry eye is likely different than that of a patient in whom dry eye symptoms occur with minimal signs of disease. 

    As a result, treatment decisions are based on patients’ underlying pathophysiology. 

    First line therapies typically include artificial tears and ointments, which can improve many facets of the disease (e.g. improve tear health, add to tear volume, coat corneal nerves). 

    Beyond artificial tears, treatment approaches involve addressing ocular surface inflammation (short course of topical corticosteroids, cyclosporine, lifitegrast, oral omega 3 supplementation), meibomian gland dysfunction (lid hygiene, oral and topical antibiotics), exposure (contact lenses, surgical correction of eyelids and conjunctivae), and neuropathic pain (autologous serum tears, oral pain medication). 

    Learn more from Dr. Galor in this video interview or take this CME case she co-authored with Roy C. Levitt, MD, and Todd P. Margolis, MD, PhD