What is Xiidra and How Does It Treat Dry Eye?
Xiidra (lifitegrast) is a prescription eye drop approved to treat the signs and symptoms of dry eye disease (DED). Unlike simple lubricating artificial tears, Xiidra targets a root cause of DED: inflammation on the surface of the eye. Its active ingredient, lifitegrast, acts as a lymphocyte function-associated antigen-1 (LFA-1) antagonist. This unique mechanism works by blocking the interaction between LFA-1 on certain immune cells and ICAM-1 on the surface of eye cells, which helps reduce the inflammatory response that causes irritation, dryness, and pain. Because it addresses the underlying inflammation, Xiidra is intended for ongoing use to manage this chronic condition effectively.
Evidence for Long-Term Efficacy
When considering a long-term treatment, evidence of sustained efficacy is critical. The available research, including real-world observational studies, provides encouraging results for long-term Xiidra use.
Clinical Trials and Real-World Data
In the initial randomized, controlled clinical trials, Xiidra was evaluated over 12 weeks, showing significant improvements in both the signs and symptoms of DED compared to a placebo. More recently, real-world observational studies have provided a clearer picture of long-term effectiveness. A 2021 study, published in Clinical Ophthalmology, followed 600 patients using Xiidra for up to 12 months. This research showed sustained improvement in DED signs and symptoms, with over 80% of patients continuing their treatment after a year. Key findings included improved tear film break-up time and reduced corneal staining at both 6 and 12 months. Another assessment presented at the 2025 ASCRS Annual Meeting showed continued efficacy for an average of 15 months, reinforcing that improvement can be durable with consistent use.
The Importance of Consistency
Dry eye is a chronic condition, and medications like Xiidra work best when used consistently as prescribed, typically twice daily. Skipping doses can prevent the medication from effectively controlling the inflammatory cycle, leading to a return of symptoms. For those who stick with the regimen, the long-term benefits are more likely to be realized. While some patients report relief within a few weeks, maximum effect can take up to 12 weeks.
Long-Term Safety Profile
For any long-term medication, safety is paramount. Extensive postmarketing analysis has shed light on Xiidra's long-term safety profile since its FDA approval in 2016.
A Favorable Safety Track Record
A comprehensive 7-year postmarketing analysis of lifitegrast was presented at the 2025 ASCRS Annual Meeting. This review, based on nearly 800,000 patient-treatment years, confirmed a favorable safety profile with no new safety signals identified during routine monitoring. The side effect profile remained consistent with clinical trial data, with most events being mild and transient. Xiidra is also preservative-free, which is a significant advantage for long-term use, as prolonged exposure to preservatives can cause additional eye irritation.
Managing Potential Side Effects
Though most side effects are temporary, it is important to be aware of them. The most common side effects reported include an unusual taste sensation (dysgeusia), eye irritation, and temporary blurred vision. The unusual taste is not harmful and occurs as the medication drains through the tear ducts. For most, temporary blurred vision resolves quickly, but in rare cases, it can persist for a longer duration and may warrant discussing discontinuation with a doctor. Serious allergic reactions are rare but possible and require immediate medical attention.
Xiidra vs. Other Long-Term Options for Dry Eye
While Xiidra offers a viable long-term solution, it is not the only one available. It's often compared to Restasis (cyclosporine), another prescription eye drop for chronic dry eye. The best option depends on individual patient factors. The following table provides a comparison based on available data:
| Feature | Xiidra (Lifitegrast) | Restasis (Cyclosporine Emulsion) |
|---|---|---|
| Onset of Action | Can provide symptom relief within 2-3 weeks, with full effect in 6-12 weeks. | May take 2-3 months to show initial symptom relief, with full effect taking up to 6 months. |
| Mechanism | An LFA-1 antagonist that blocks inflammatory cell adhesion to reduce inflammation. | A calcineurin inhibitor that blocks the activation of T-cells to reduce inflammation. |
| Long-Term Efficacy | Real-world studies show sustained improvement over 12 months for many patients. | Established efficacy for long-term use in increasing tear production. |
| Long-Term Safety | Favorable 7-year postmarketing data; most side effects are mild and transient. | Generally well-tolerated long-term; common side effects include burning and irritation. |
| Cost | Only available as a brand-name medication, potentially higher cost. | Generic versions are available, often a more affordable long-term option. |
Patient Experience and Expectations
An individual's experience with Xiidra can vary, and it is important to set realistic expectations. For many patients, Xiidra is highly effective long-term, leading to sustained relief from symptoms. However, some anecdotal reports exist of patients experiencing a reduced effect over time or a worsening of symptoms after long-term use. Real-world studies, such as the one in Clinical Ophthalmology, show high rates of patient persistence with the medication over a year, suggesting widespread satisfaction and continued effectiveness. Patient-reported outcomes, such as higher satisfaction with Xiidra's speed of relief compared to other options, also play a significant role in continued use. Communicating with your eye care professional is vital if you feel the medication is no longer working as well as it once did. Adjustments or combination therapies might be recommended.
Conclusion
For patients with chronic dry eye, the answer to the question, does Xiidra work long term? is a reassuring "yes" for many. Long-term studies and extensive postmarketing data demonstrate that Xiidra offers sustained efficacy and maintains a favorable safety profile over several years of use. While individual response and tolerance can vary, consistent use helps manage the underlying inflammation that drives the condition. As with any chronic condition, regular follow-ups with an ophthalmologist or optometrist are essential to monitor progress and address any concerns regarding effectiveness or side effects over the long term. For those needing a long-term treatment that tackles the root cause of inflammation, Xiidra remains a proven and well-tolerated option.
