A Game Changer in the Treatment of Dry Eye

Christopher J. Rapuano, MD; Parveen K. Nagra, MD


July 26, 2016

Editorial Collaboration

Medscape &

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Christopher J. Rapuano, MD: Hi. I'm Dr Christopher Rapuano and I'm here with my partner, Dr Parveen Nagra. I'm the chief of the Cornea Service at Wills Eye Hospital, and we're coming to you from the Wills Eye Alumni Society newsroom at Wills Eye Hospital in Philadelphia.

This is a collaboration between Wills Eye Hospital and Medscape Ophthalmology.

We are here today because there is a new medication that was recently approved by the US Food and Drug Administration (FDA) for the treatment of dry eye syndrome. It's called Xiidra™; the generic name is lifitegrast [ophthalmic solution]. It has been in trials for a long time.

Parveen, why is this a big deal? Why do we even care about this new medication? Don't we have medications for dry eye?

Parveen K. Nagra, MD: This is a very big deal because dry eye is an enormous problem for many of our patients. Patients can be very symptomatic from dry eyes, with irritation, discomfort, redness, and blurred vision. We do have treatments that work, but there is always room for more. We have artificial tears and we have an anti-inflammatory medicine, Restasis® (cyclosporine ophthalmic emulsion). We can occasionally try different antibiotics or thicker lubricants and oral medications, but there are patients for whom we are not adequately treating dry eyes who remain symptomatic. So, this is very promising for those patients.

Dr Rapuano: I agree. This is the first FDA-approved prescription medication for dry eye since Restasis, which was back in 2003. We are very excited, as ophthalmologists and corneal specialists, to have a new medication on the market. Which patients do you think this might be used for?

Dr Nagra: That's a good question. We have lots of different patients for whom we could try this, certainly patients for whom artificial tears aren't enough. We have a lot of patients on Restasis, and although we have some who do well on Restasis, in others it fails. Some patients are okay on Restasis but may need something additional. Patients who can't tolerate Restasis or those who are more symptomatic would also benefit.

At this point, trying it on many of our patients would be the approach—patients who have a lot of the symptoms and clinical signs of dry eyes.

Dr Rapuano: I agree completely. This will be a big game changer in the treatment of dry eye. It was studied for numerous years in four different FDA trials with over 1000 patients. It's a twice-daily medication (like Restasis) so it's pretty easy to use. It was well tolerated in the studies and had a good effect on dryness in a statistically significant number of patients.[1]

Dry eye is common. It's more common as people get older, and it's more common in women. We know that our population is aging. There may even be a syndrome associated with computer use, which causes dry eyes or makes it worse. I think there is big potential for this.

Dr Nagra: I agree. I'm excited to start using it.

Dr Rapuano: Me, too. I'm Chris Rapuano, with Parveen Nagra. We're from the Cornea Service at Wills Eye Hospital in Philadelphia. Thank you very much.