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How Does Xiidra Work?

Key Takeaways

  • Xiidra (lifitegrast ophthalmic solution) is an FDA-approved prescription eye drop used twice daily to treat the signs and symptoms of dry eye disease.
  • Xiidra works by targeting inflammation, specifically by blocking LFA-1 (lymphocyte function-associated antigen-1), which reduces T-cell activity on the ocular surface.
  • Unlike artificial tears, which only lubricate the eye, Xiidra addresses the underlying inflammatory process responsible for chronic dry eye.
  • Xiidra comes in single-use vials, and while effective, it may cause side effects such as eye irritation, blurred vision, or an unusual taste sensation.
  • Treatment decisions should be made with your eye doctor or healthcare provider as part of a personalized dry eye treatment plan.

What Is Xiidra?

Xiidra is a prescription eye drop used for dry eye disease, also called dry eye syndrome. Manufactured by Bausch, the medication contains the active ingredient lifitegrast, which targets inflammation that affects the tear film and cornea.

Dry eye disease occurs when:

  • Your eyes don’t make enough natural tears,
  • Your tears evaporate too quickly (often from meibomian gland dysfunction), or
  • The ocular surface becomes irritated and inflamed.

Xiidra is one of several treatment options, along with cyclosporine (Restasis, Cequa), lubricating drops, punctal plugs, warm compresses, and steroid drops.

Xiidra’s Mechanism of Action (The Science in Simple Terms)

To understand how Xiidra works, it helps to know that dry eye disease is often driven by inflammation. Inflammation on the ocular surface leads to redness, irritation, stinging, burning, and blurred vision.

Xiidra blocks LFA-1, a key inflammatory pathway

Xiidra’s active ingredient, lifitegrast, blocks a protein called LFA-1 (lymphocyte function-associated antigen-1). LFA-1 binds to ICAM-1 on cells in the eye and triggers T-cell activation and inflammation.

When lifitegrast blocks LFA-1:

  • Fewer inflammatory cells stick to the ocular surface
  • T-cell activity decreases
  • The cycle of inflammation is disrupted
  • The tear film stabilizes

This helps reduce the underlying irritation causing symptoms of dry eye disease.

Xiidra improves the quality of the tear film

The tear film has three layers: oil, water, and mucus. Inflammation disrupts these layers, causing dryness and vision fluctuations. By reducing inflammation, Xiidra supports:

  • Better tear stability
  • Reduced evaporation
  • Less irritation on the cornea

It treats the cause, not just the moisture

While over-the-counter artificial tears only lubricate and give temporary moisture, Xiidra works at the inflammatory source that causes long-term dryness.

How to Use Xiidra

Most patients are instructed to use Xiidra single-use vials twice daily, approximately 12 hours apart.

Some general guidelines include:

  • Wash your hands before instillation.
  • Remove contact lenses before administering the drops. They can be reinserted at least 15 minutes after instillation.
  • Remove one single-use container from its foil pouch just before use.
  • Hold the container upright and tap the top gently to ensure all the solution is in the bottom part.
  • Twist off the tab to open the container.
  • Tilt your head backward or lie down.
  • Gently pull your lower eyelid downward with a finger to create a small pocket.
  • Gently squeeze the vial and let one drop of Xiidra fall into the pocket. Do not touch your eye with the tip of the vial.
  • If the drop misses, use the extra solution in the container to try again.
  • Discard the vial after use (even if leftover liquid remains).

How Long Does Xiidra Take to Work?

Some people feel symptom relief in as little as 2 weeks, though full benefit may take:

  • 6–12 weeks for many patients.
  • Longer in those with severe inflammation or meibomian gland dysfunction.

Dry eye disease is chronic, so ongoing treatment is typically necessary.

How Xiidra Compares to Other Dry Eye Treatments

Xiidra vs. Restasis/Cequa (cyclosporine)

  • Xiidra blocks LFA-1 to reduce inflammation.
  • Restasis and Cequa increase tear production by affecting T-cell function differently.
    Some patients respond better to one than the other.

Xiidra vs. artificial tears

  • Lubricating drops treat surface dryness and only provide temporary relief.
  • Xiidra treats the inflammation behind dry eye disease.

Xiidra vs. steroid drops

  • Steroids can quickly reduce inflammation, but are not ideal for long-term use.
  • Xiidra is intended as a long-term therapy with a better safety profile.

Your eye care specialist may combine treatments depending on severity.

Side Effects of Xiidra

Most side effects are mild and temporary. Some of the most common side effects include:

  • Eye irritation or burning upon instillation
  • Blurred vision
  • Eye dryness
  • Unusual taste (a metallic or salty sensation)

These typically improve with continued use.

Potential side effects (less common)

  • Increased tearing
  • Mild headache
  • Temporary blurry vision

Serious side effects (rare)

Seek care for:

  • Severe allergic reaction
  • Persistent eye pain

Your healthcare provider should evaluate any significant change in vision or severe discomfort.

Why Xiidra Comes in Single-Use Vials

Xiidra is packaged in sterile, single-use vials to:

  • Avoid preservatives that irritate the ocular surface.
  • Ensure exact dosing.
  • Reduce contamination risk.

While convenient and safer for sensitive eyes, single-use packaging contributes to the higher cost of the medication.

How Long Do You Need to Use Xiidra?

Dry eye disease is usually treated long-term for months or years as part of an ongoing treatment plan that may include:

  • Warm compresses
  • Omega-3 supplements
  • Artificial tears
  • Eyelid hygiene
  • Treatment of meibomian gland dysfunction
  • Punctal plugs

Your eye doctor may adjust therapy based on your response.

Who Should Not Use Xiidra?

Consult a provider if you:

  • Have a history of severe allergies.
  • Are breastfeeding.
  • Have had recent eye infections.
  • Have had recent eye surgery.

Always follow personalized medical advice.

FAQs

How does Xiidra work for chronic dry eye?
It blocks LFA-1 to reduce inflammation, improving tear film stability and eye comfort.

Can I use artificial tears with Xiidra?
Yes. Lubricating drops can be used between Xiidra doses for additional moisture.

Does Xiidra improve blurred vision?
By improving the tear film, it can indirectly help. However, some blurry vision may occur temporarily after instillation.

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