Xiidra from Shire is the first in a class of drugs known as lymphocyte function-associated antigen-1 (LFA-1) antagonists.
The Refresh brand of artificial tears from Allergan offers myriad choices for dry eye relief.
The Retaine line from OCuSOFT has many solutions for patients with dry eye or meibomian gland dysfunction.

Six Rx and OTC options for patients with ocular surface disease.

The hottest topic in optometry right now is….dry eye? While studies estimate more than 30 million people suffer from dry eye disease, it has not been in the spotlight. That’s because many patients suffer in silence, believing dry eyes to be a normal part of aging or contact lens wear, or they have a lack of improvement in symptoms and fail to continue treatment.

However, with the first new prescription drug in 13 years hitting the market in 2016, along with a full national campaign with star presence, patients will be more likely than ever to speak to their eyecare professionals (ECPs) about their symptoms.

As practitioners, we are at the forefront of treatment for these patients, and we have an arsenal full of both over-the-counter and Rx treatments at our disposal.

Allergan’s Restasis (cyclosporine 0.05%), the first treatment approved by the FDA for treatment of dry eye in 2002, is an ophthalmic emulsion that increases tear production suppressed by ocular inflammation associated with keratoconjunctivitis sicca. While the exact mechanism of action is unknown, Restasis is believed to be an anti-inflammatory agent, preventing T-cells from releasing cytokines, which leaves the tissue of the lacrimal glands and ocular surface intact. This may prevent damage to the tissues, which could affect the quality and quantity of tears, and actually can promote normal tear production. Restasis is sterile, preservative free, dosed BID and can be used along with artificial tears or topical steroids. It is now available in a multi-dose bottle (see page 30). The most common adverse reaction when using Restasis is burning on installation.

In mid-July, Xiidra (lifitegrast 5% ophthalmic solution) from Shire, was approved by the FDA to treat both the signs and symptoms of dry eye, and it is the first in a class of drugs known as lymphocyte function-associated antigen-1 (LFA-1) antagonists. Lifitegrast binds to the integrin lymphocyte function-associated antigen-1 (LFA-1), a cell surface protein found on leukocytes, and blocks the interaction of LFA-1 with its cognate ligand intercellular adhesion molecule-1 (ICAM-1). ICAM-1 may be overexpressed in corneal and conjunctival tissues in dry eye disease. LFA-1/ICAM-1 interaction can contribute to the formation of an immunological synapse, resulting in T-cell activation and migration to target tissues. In vitro studies demonstrated that lifitegrast may inhibit T-cell adhesion to ICAM-1 in a human T-cell line and may inhibit secretion of inflammatory cytokines in human peripheral blood mononuclear cells. The exact mechanism of action of lifitegrast in dry eye disease is not known.

Early clinical usage is promising, with some dry eye patients experiencing a reduction in their symptoms in as early as two weeks; patients in clinical studies had a large reduction in their Eye Dryness Score (EDS) at six and 12 weeks. The most common side effects (incidence 5-25%) of Xiidra include instillation site irritation, an unusual taste sensation (dysgeusia) and blurred vision (decreased visual acuity). Xiidra is a preservative-free solution that comes in individual vials and has BID dosing.

The Refresh brand of artificial tears by Allergan promises patients myriad choices for relief.  Refresh Optive Advanced stabilizes the tear film layer by layer, reduces tear evaporation, hydrates the aqueous layer, and lubricates and protects the mucin layer. Refresh Optive and Refresh Plus are preservative free and protect the surface of the eye, while adding moisture for the tear film. These are both recommended for dryness in post-LASIK patients. Refresh Optive Gel Drops are a more viscous tear that delivers a shear-thinning effect, providing patients with a significant reduction in dry eye symptoms. Refresh Celluvisc, a preservative-free gel, provides long-lasting relief for dry eyes during either day or night. For nighttime protection, Refresh PM (mineral oil 42.5%, white petrolatum 57.3%) and Refresh Lacri-lube (mineral oil 42.5%, white petrolatum 56.8%) help protect from dryness and exposure.

OCuSOFT’s line of lubricant eye drops and artificial tears, Retaine has many solutions for dry eye and meibomian gland dysfunction. Retaine MGD Emulsion (preservative-free, single-dose vials) works by using electrostatic attraction to stabilize the tear film. Retaine HPMC Lubricant Eye Drops consists of a preservative-free, hypromellose ophthalmic solution (0.3%) that delivers multiple sterile doses to the eye with no preservatives and guaranteed sterility after opening. Retaine PM is an oil-based, preservative-free formula for overnight protection. For patients suffering from dry eye caused by environmental factors or prolonged computer use, single-dose vials of Retaine CMC Lubricant Eye Drops with carboxymethylcellulose sodium 0.5% will provide immediate relief.

Soothe XP
Dry eye can happen when the eye’s outer protective lipid layer breaks down. Soothe XP emollient (lubricant) eye drops contain Restoryl mineral oils. Soothe XP helps restore this layer, seal in moisture and protect against further irritation.

Alcon’s Systane offers multiple ways to help relieve dry eye symptoms. SYSTANE¬† BALANCE helps support the three layers of the tear film, especially the delicate lipid layer. SYSTANE Gel Drops create a barrier of protection using the coverage of a gel combined with the convenience of a drop. SYSTANE ULTRA provides high performance, long-lasting relief for patients with dry eye symptoms and is also available in preservative-free, single-use vials. For patients needing nighttime protection, SYSTANE Lubricant Eye Gel offers the thickest formulation for lasting relief.

Dry eye is one of the most common conditions that brings patients into our offices for treatment. An aging population, increased use of computers and screens, a large number of patients on systemic medications and a national advertising campaign will continue to drive these patients to ECPs for treatment. We are now armed with more options than before to help these patients gain better comfort and relief.

Jennifer L. Stewart, OD, is a partner at Norwalk Eye Care, in Norwalk, CT. She is also the co-founder and chief optometric officer at Performance 20/20, a sports and performance vision clinic, in Stamford, CT.


Alcon Laboratories
800.451.3937 |

800.347.4500 |

Bausch + Lomb
800.553.5340 |

800.233.5469 |

617.349.0200 |


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