From the Guidelines
For chronic LASIK dry eye, Xiidra (lifitegrast) is recommended over Restasis (cyclosporine) due to its potentially faster symptom relief and mechanism of action in reducing inflammation by blocking T-cell activation. According to the most recent study from 2024 1, lifitegrast ophthalmic solution 5% was approved by the FDA for the treatment of signs and symptoms of dry eye syndrome, and it has shown benefit in signs and symptoms over a period of 3 months. In contrast, cyclosporine, the active ingredient in Restasis, may take 1-3 months for full effect and has a different mechanism of action, increasing tear production by preventing activation and nuclear translocation of cytoplasmic transcription factors that are required for T-cell activation and inflammatory cytokine production 1.
Key differences between Xiidra and Restasis include:
- Mechanism of action: Xiidra blocks T-cell activation, while Restasis increases tear production
- Onset of action: Xiidra may offer faster symptom relief, with improvement seen within 2 weeks, while Restasis may take 1-3 months for full effect
- Side effects: Xiidra commonly causes temporary burning/irritation and altered taste sensation, while Restasis typically causes burning upon application
It's essential to use these prescription medications alongside preservative-free artificial tears as needed throughout the day and to continue treatment as directed even after symptoms improve, as consistent use is crucial for their effectiveness 1. Additionally, patients with dry eye syndrome considering keratorefractive and lens-based surgery should be cautioned that dry eye symptoms could become worse after surgery, and pre-existing factors contributing to dry eye syndrome should be improved preoperatively to reduce the chance of worsened dry eye syndrome 1.
From the Research
Treatment Options for Chronic LASIK Dry Eye
- Xiidra and Restasis are two treatment options for chronic dry eye, including those caused by LASIK surgery.
- Restasis (cyclosporine ophthalmic emulsion 0.05%) is indicated to increase tear production in patients with dry eye and reduced tear production presumed to be due to ocular inflammation 2, 3, 4.
- Studies have shown that Restasis can be effective in treating dry eye, with improvements in tear volume, ocular surface staining, and artificial tear use 2, 3, 4.
- One study found that the use of Restasis after LASIK surgery was associated with faster recovery of visual acuity compared to a standard postoperative regimen 5.
Comparison of Xiidra and Restasis
- There is limited direct comparison between Xiidra and Restasis in the provided studies.
- However, Restasis has been shown to be effective in treating dry eye, including in patients with chronic LASIK dry eye 2, 3, 4, 5.
- Xiidra (lifitegrast ophthalmic solution 5%) is also used to treat dry eye, but its effectiveness compared to Restasis is not directly addressed in the provided studies.
Treatment Considerations
- The treatment of dry eye disease should include a detailed patient history, thorough slit-lamp examination, and additional tests as indicated 6.
- Artificial tears, lid hygiene, and punctal occlusion may also be used to treat dry eye, depending on the severity and underlying cause of the disease 3, 6.
- Topical anti-inflammatory treatment, such as cyclosporine A, may be beneficial for moderate or severe dry eye disease 6, 4.