It’s a great question! I don’t know if they really know how Xiidra or Restasis works. They always say they have a mechanism of maximum but then they kind of tell us they don’t know how they work.
They are both used to treat dry eye. That is what they’re FDA approved for. Truthfully, we could go really deep into this on how both of them work but nobody’s going to understand that. I think knowing that they work differently is really what is important here. You can use both of them at the same time because of the fact that they do work in a different way. They work on different parts of your immune system. The goal is the same though, they both decrease your immune systems response to inflammation. What we know is happening is, dry eye is causing inflammation that’s causing the irritation. If we decrease that immune response, my belief is this is not really fixing the problem but just shutting down your immune system. Sometimes that's needed and that’s what immune suppressants are. They shut down your immune system because your immune system is overacting to a mechanism in your body. Figuring out the cause of that and then moving from there is my opinion on it.
I think it’s pretty rare that we would prescribe both of them. I think Restasis is a little annoying because it does take a while to work. In most people it can take about six months, where Xiidra is about one to two to three. Xiidra works a lot quicker so that’s the nice thing about Xiidra. It is technically approved for the signs and symptoms of dry eye. It’s pretty rare that I prescribed them both, or prescribe either of them. We tend to treat more holistically first and then we’ll move to prescriptions second. I will move to a prescription quickly if the patient’s very symptomatic, but I tend to do more steroids long term before I do Restisis long term or Xiidra. I’ll do a topical steroid short term before we even try Restasis at all because we want to make sure that there’s an inflammatory component to your dry eye. Steroids are a good indication of that. If you feel better from steroids, you’re going to usually do well with Xiidra or Restasis.
I’m going to come out with a new video series soon about how we treat in order. It’s going to be a 12-part series mostly because we go pretty in depth of dry eye. Again, we push more holistic healing even though we are both doctors. You’re not going to see that too often because we’re not trained that way in school.
Drs. Travis and Jenna Zigler
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