Addressing Inflammatory Dry Eye

Dry eye disease (DED) continues to present a significant clinical and therapeutic challenge across ophthalmology, with implications that extend well beyond ocular surface discomfort.

Tear film integrity is foundational to visual quality and surgical precision. As Eric D. Donnenfeld, MD, noted in a recent episode of Innovation Journal Club, “vision starts with the tear film,” making DED management critical not only in cornea and refractive practices, but also in glaucoma and cataract surgery. Subclinical or undertreated dry eye can significantly affect keratometry, biometry, and ultimately refractive outcomes, underscoring the need for routine ocular surface optimization.

For patients with suspected inflammatory DED, lifitegrast (Xiidra; Bausch + Lomb) has emerged as a key therapeutic option. Dr. Donnenfeld described it as his “go-to” immunomodulator due to its ability to address the underlying inflammatory cascade rather than simply providing symptomatic relief. In real-world data discussed during the episode, which were from a cross-sectional survey of 12 eye care providers (6 ophthalmologists, 6 optometrists) with experience prescribing lifitegrast for DED, both clinicians and patients reported meaningful improvements, with objective signs such as reduced corneal staining and improved tear film stability accompanied by subjective symptom relief (Figure 1).¹ The survey also found that eye care providers expressed moderate-to-high levels of satisfaction with lifitegrast overall (7.1 on a 10-point scale), with most of the respondents stating that patients often find relief from symptoms early in the treatment course (Figure 2).¹

Although lifitegrast is a mainstay of DED therapy, Dr. Donnenfeld stressed that DED is rarely a monotherapy disease, saying that combination therapy is often necessary, particularly in patients with mixed-mechanism disease. He encouraged clinicians to set expectations early, framing treatment as an iterative process. Establishing this understanding preemptively, he said, can improve adherence and reduce dissatisfaction when initial therapies yield only partial improvement.

“One therapy is not always enough for every single patient,” Dr. Donnenfeld said, adding that “having dual therapy sometimes is optimal for these patients.”