This is a single-center, randomized, controlled trial to evaluate the safety and efficacy of eyelash prostheses versus 5.0% Lifitegrast BID, in 40 patients (20 randomized to each of two arms of the study) evaluated at 3 weeks and 5 weeks, respectively, after initiation of treatment.

This is a single center, randomized, controlled clinical trial to evaluate the tolerability, efficacy, and safety of eyelash prostheses over a 3-week period versus Xiidra BID over a 5 week period in subjects with self-reported DED. 40 subjects will be randomized to either eyelash prostheses or Xiidra, in a 1:1 ratio.

At Visit 1 (screening), informed consent will be obtained from subjects and eligibility will then be determined. All pre-treatment assessments will be done at this visit. Randomization will occur. If randomized to receive Xiidra eye drops, a prescription will be written and the treatment will be started right away. If randomized to eyelash prostheses, then a second study visit will be made approximately 2 weeks later.

Visit 2 (Eyelash Prostheses application) Subjects randomized to receive eyelash prostheses will have them applied approximately 2 weeks after the screening and randomization visit.

Visit 3 (Final visit) will be 3 weeks post eyelash prosthesis placement and 5 weeks post Xiidra eye drop initiation. This was done to compare the maximal treatment effect between the two groups. All subjects will undergo post-treatment assessments.

At each visit, patients will be asked to report any adverse events.

Inclusion Criteria:

1. Self-reported dry eye symptoms

2. Tear Break Up Time of less than 10 seconds as assessed by the Oculus Keratograph (see Appendix A).

3. SPEED II Score greater than 25

4. Men or Women, age between 50 and 90 inclusive

5. Willingness to undergo both pre-treatment and post-treatment testing per the protocol

6. Willingness to endure the 2-3 hour time required to place eyelash extensions, if randomized to this treatment arm

7. Willingness to use eye drops for dry eyes and fill a prescription through insurance coverage, if randomized to this treatment arm

8. Willingness to attend all study visits

9. Willingness to sign informed consent and liability waiver

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Exclusion Criteria:

1. Absence of eyelashes

2. Eyelash disease such as clinically significiant demodex, blepharitis, meibomitis

3. Be unable or unwilling to give written informed consent and/or to comply with study procedures.

4. Have any known hypersensitivity or contraindication to study treatments (including excipients), topical anesthetics or vital dyes.

5. Be unable to demonstrate correct instillation of over the counter (OTC) ocular lubricant during Visit 1.

6. Have clinically significant ocular surface disease in either eye (e.g., corneal edema, uveitis, severe keratoconjunctivitis sicca) which might interfere with study safety procedures, or assessments.

7. Have clinically significant systemic disease (e.g., uncontrolled diabetes, hepatic, renal, endocrine or cardiovascular disorders) which might interfere with the study at Visit 1 and 2.

8. Current use of Restasis or Xiidra at the time of Visit 1

9. Changes in the dose of, or the initiation of, any medications that are known to affect dry eyes within 90 days of Visit 1 or during the duration of the study.

10. Any history of Herpes simplex of Herpes zoster affecting the eye or head.

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There is no plan to share data