Dry Eye Demystified: A Closer Look at Xiidra® (lifitegrast ophthalmic solution) 5% for DED Inflammation

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Dry eye is showing up in exam lanes every day—and for many practices, it represents one of the most consistent opportunities to improve patient comfort, visual stability, and long-term trust. In this Defocus Media Podcast episode, Dr. Darryl Glover and Dr. Jennifer Lyerly are joined by dry eye specialist Dr. Jackie Garlich to discuss real-world dry eye care, focusing on identifying symptoms, confirming diagnosis with practical tools, and addressing inflammation with therapies such as Xiidra.^1* 

Dr. Glover opens the conversation by noting that over 38 million people suffer from chronic dry eye, reinforcing a central theme of the discussion: dry eye cannot be ignored in primary eye care. Dr. Garlich adds important context by highlighting that patient satisfaction with dry eye treatment remains low, emphasizing a gap between how often dry eye is treated and how effectively it is managed. Together, the panel frames dry eye as both a patient-care responsibility and a significant opportunity for clinicians to improve outcomes.

Understanding Dry Eye and Why It Gets Missed

Dry eye affects people of all ages and demographics, often manifesting as discomfort, fluctuating vision, watering, burning, or difficulty wearing contact lenses throughout the day.² One of the recurring points made by the panel is that dry eye is frequently underdiagnosed—not because it is rare, but because symptoms are not always uncovered during the exam.

Rather than asking patients a broad question such as “Do you have dry eye?”, the panel encourages more targeted, functional questions. Dr. Garlich notes that fluctuating vision is commonly overlooked because patients do not instinctively associate it with dry eye, and clinicians may not always ask about it. End-of-day discomfort, contact lens intolerance, and visual instability during prolonged screen use are examples of symptoms warranting further evaluation.

To help prioritize chair time and align expectations, Dr. Garlich describes asking patients how bothered they are on a scale of one to ten. Dr. Lyerly explains that this approach helps clinicians determine whether a symptom requires immediate intervention or can be documented and monitored.

Confirming Dry Eye in Real-World Practice

A key takeaway from the discussion is that clinicians do not need advanced technology to start treating dry eye more effectively. Dr. Garlich emphasizes that diagnosis can begin with minimal investment: listening carefully to patient symptoms, instilling fluorescein, evaluating tear breakup time, and manually expressing the meibomian glands at the slit lamp.

From there, additional testing can be layered in depending on clinic flow and whether the visit is a comprehensive exam or a dedicated dry eye workup. Dr. Garlich describes using meibography imaging and additional diagnostic tools—such as MMP-9 testing, Schirmer testing, and lissamine green staining—when clinically appropriate. Dr. Lyerly shares a streamlined approach during comprehensive exams, reserving more in-depth testing for follow-up visits when time allows.

The shared message is clear: starting with the basics allows clinicians to identify dry eye consistently and build confidence before expanding their diagnostic process.

Addressing Inflammation in Dry Eye

Throughout the episode, the panel emphasizes that dry eye is often an inflammatory condition and that meaningful improvement often requires addressing inflammation on the ocular surface. Dr. Garlich explains that when inflammation is left untreated, patients may continue to struggle even with in-office procedures or supportive therapies.

Xiidra^® (lifitegrast ophthalmic solution) is discussed as an option that targets inflammation by inhibiting T-cell activation involved in the inflammatory cascade.^1* Dr. Garlich explains that calming this inflammatory process is critical to helping patients improve both clinically and symptomatically.

A consistent theme is patient expectation. Dr. Garlich notes that patients often do not want to wait months to feel better, and Xiidra has demonstrated improvement in signs and symptoms within as little as two weeks,^1† which can play an important role in patient adherence. Dr. Glover reinforces that when patients experience early improvement, they are more likely to stay engaged with their treatment plan.

Positioning Xiidra Among Treatment Options

The panel acknowledges that steroids can reduce redness and discomfort in inflamed eyes, but they are not a long-term solution for chronic dry eye management. Dr. Lyerly highlights the importance of non-steroid anti-inflammatory therapies for sustained control of inflammation.

Cyclosporine is discussed as another anti-inflammatory option with a longer onset of action, while Xiidra is often considered when earlier symptom improvement is a priority.* The discussion emphasizes that treatment selection should align with patient presentation, expectations, and clinical findings.

The Importance of Follow-Up

Follow-up is presented as an essential part of successful dry eye management. Dr. Garlich often schedules follow-up around eight weeks after starting an immunomodulator to confirm that patients obtained the medication, are tolerating it, and are seeing improvement.

Dr. Glover describes a flexible one- to three-month follow-up approach based on patient reliability and engagement, while Dr. Lyerly often schedules four to six weeks and tracks objective measures such as tear breakup time. She explains that showing patients measurable improvement reinforces confidence in the treatment plan and demonstrates that their concerns are being taken seriously.

Patient Engagement and Long-Term Confidence

Rather than focusing on a single case study, Dr. Garlich describes a consistent pattern seen in practice: patients do best when symptom relief, clinical findings, and inflammation metrics align. She notes that repeating tests, such as MMP-9, after treatment initiation can visually reinforce progress for patients.

Reducing barriers to care also matters. Xiidra is well covered in many settings,^3‡ allowing patients to begin therapy without unnecessary delays that can disrupt momentum and adherence.

Conclusion

Dry eye is everywhere, and clinicians who fail to recognize and address it risk leaving patient needs unmet. As the panel emphasizes, treating dry eye does not require immediate investment in advanced technology—it starts with better questions, basic examination techniques, and a commitment to follow-up.

Dr. Glover reinforces that clinicians can begin by expressing glands, staining the surface, and checking tear breakup time, then build from there. When inflammation is a key driver, Xiidra is positioned as a practical, real-world option that can help patients feel improvement early and support long-term confidence in their care.

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.

Please see full Prescribing Information for Xiidra at XIIDRA-ECP.COM.