www.xiidra.com
Open in
urlscan Pro
2606:4700:4400::6812:245a
Public Scan
Submitted URL: http://xiidra.com/
Effective URL: https://www.xiidra.com/
Submission Tags: tranco_l324
Submission: On May 31 via api from DE — Scanned from SE
Effective URL: https://www.xiidra.com/
Submission Tags: tranco_l324
Submission: On May 31 via api from DE — Scanned from SE
Form analysis 1 forms found in the DOM
POST
<form method="post" novalidate="novalidate" data-f-metadata="" aria-labelledby="d9d9a563-8c53-4fd8-822d-1d82aa0bc2ef_label" enctype="multipart/form-data" class="EPiServerForms ValidationSuccess" data-f-type="form"
id="d9d9a563-8c53-4fd8-822d-1d82aa0bc2ef">
<script type="text/javascript" data-cmp-info="5">
// This view acts as a rendering template to render InitScript(and server-side Form's descriptor) in FormContainerBlock's client-side for Form[d9d9a563-8c53-4fd8-822d-1d82aa0bc2ef].
// TECHNOTE: all serverside (paths, dynamic values) of EPiServerForms will be transfered to client side here in this section.
(function initializeOnRenderingFormDescriptor() {
// each workingFormInfo is store inside epi.EPiServer.Forms, lookup by its FormGuid
var workingFormInfo = epi.EPiServer.Forms["d9d9a563-8c53-4fd8-822d-1d82aa0bc2ef"] = {
Id: "d9d9a563-8c53-4fd8-822d-1d82aa0bc2ef",
Name: "Xiidra-DTC-Quiz-Form",
// whether this Form can be submitted which relates to the visitor's data (cookie, identity) and Form's settings (AllowAnonymous, AllowXXX)
SubmittableStatus: {
"submittable": true,
"message": ""
},
ConfirmMessage: "",
ResetConfirmMessage: "",
ShowNavigationBar: true,
FocusOnForm: false,
ShowSummarizedData: false,
// serialize the dependency configuration of this form to clientside
DependenciesInfo: JSON.parse("[]"),
// keep all fieldName which are not satisfied the field dependency conditions
DependencyInactiveElements: [],
// Validation info, for executing validating on client side
ValidationInfo: JSON.parse(
"[{\"targetElementName\":\"__field_167886\",\"targetElementId\":\"36d0a5d3-427d-4a96-983e-9c315a5e600f\",\"validators\":[{\"type\":\"EPiServer.Forms.Implementation.Validation.RequiredValidator\",\"description\":null,\"model\":{\"message\":\"Please enter your first name to continue.\",\"validationCssClass\":\"ValidationRequired\",\"additionalAttributes\":{\"required\":\"\",\"aria-required\":\"true\"}}},{\"type\":\"EPiServer.Forms.Implementation.Validation.RegularExpressionValidator\",\"description\":null,\"model\":{\"jsPattern\":\"^([a-zA-Z]+)$\",\"dotNetPattern\":\"^([a-zA-Z]+)$\",\"message\":\"This field should be in a-z, A-Z format.\",\"validationCssClass\":null,\"additionalAttributes\":null}}]},{\"targetElementName\":\"__field_167887\",\"targetElementId\":\"42f14bd1-b20a-42c2-b23f-e4483533cb08\",\"validators\":[{\"type\":\"EPiServer.Forms.Implementation.Validation.RequiredValidator\",\"description\":null,\"model\":{\"message\":\"Please enter your last name to continue.\",\"validationCssClass\":\"ValidationRequired\",\"additionalAttributes\":{\"required\":\"\",\"aria-required\":\"true\"}}},{\"type\":\"EPiServer.Forms.Implementation.Validation.RegularExpressionValidator\",\"description\":null,\"model\":{\"jsPattern\":\"^([a-zA-Z]+)$\",\"dotNetPattern\":\"^([a-zA-Z]+)$\",\"message\":\"This field should be in a-z, A-Z format.\",\"validationCssClass\":null,\"additionalAttributes\":null}}]},{\"targetElementName\":\"__field_167888\",\"targetElementId\":\"9b9dfaed-affb-4897-b4f7-633e4aec550f\",\"validators\":[{\"type\":\"EPiServer.Forms.Implementation.Validation.RequiredValidator\",\"description\":null,\"model\":{\"message\":\"Please enter a valid e-mail address to continue.\",\"validationCssClass\":\"ValidationRequired\",\"additionalAttributes\":{\"required\":\"\",\"aria-required\":\"true\"}}},{\"type\":\"EPiServer.Forms.Implementation.Validation.EmailValidator\",\"description\":null,\"model\":{\"jsPattern\":\"^((([a-zA-Z]|\\\\d|[!#\\\\$%\u0026\u0027\\\\*\\\\+\\\\-\\\\/=\\\\?\\\\^_`{\\\\|}~]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])+(\\\\.([a-zA-Z]|\\\\d|[!#\\\\$%\u0026\u0027\\\\*\\\\+\\\\-\\\\/=\\\\?\\\\^_`{\\\\|}~]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])+)*)|((\\\\x22)((((\\\\x20|\\\\x09)*(\\\\x0d\\\\x0a))?(\\\\x20|\\\\x09)+)?(([\\\\x01-\\\\x08\\\\x0b\\\\x0c\\\\x0e-\\\\x1f\\\\x7f]|\\\\x21|[\\\\x23-\\\\x5b]|[\\\\x5d-\\\\x7e]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])|(\\\\\\\\([\\\\x01-\\\\x09\\\\x0b\\\\x0c\\\\x0d-\\\\x7f]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF]))))*(((\\\\x20|\\\\x09)*(\\\\x0d\\\\x0a))?(\\\\x20|\\\\x09)+)?(\\\\x22)))@((([a-zA-Z]|\\\\d|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])|(([a-zA-Z]|\\\\d|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])([a-zA-Z]|\\\\d|-|\\\\.|_|~|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])*([a-zA-Z]|\\\\d|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])))\\\\.)+(([a-zA-Z]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])|(([a-zA-Z]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])([a-zA-Z]|\\\\d|-|\\\\.|_|~|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])*([a-zA-Z]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])))\\\\.?$\",\"dotNetPattern\":\"^((([a-zA-Z]|\\\\d|[!#\\\\$%\u0026\u0027\\\\*\\\\+\\\\-\\\\/=\\\\?\\\\^_`{\\\\|}~]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])+(\\\\.([a-zA-Z]|\\\\d|[!#\\\\$%\u0026\u0027\\\\*\\\\+\\\\-\\\\/=\\\\?\\\\^_`{\\\\|}~]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])+)*)|((\\\\x22)((((\\\\x20|\\\\x09)*(\\\\x0d\\\\x0a))?(\\\\x20|\\\\x09)+)?(([\\\\x01-\\\\x08\\\\x0b\\\\x0c\\\\x0e-\\\\x1f\\\\x7f]|\\\\x21|[\\\\x23-\\\\x5b]|[\\\\x5d-\\\\x7e]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])|(\\\\\\\\([\\\\x01-\\\\x09\\\\x0b\\\\x0c\\\\x0d-\\\\x7f]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF]))))*(((\\\\x20|\\\\x09)*(\\\\x0d\\\\x0a))?(\\\\x20|\\\\x09)+)?(\\\\x22)))@((([a-zA-Z]|\\\\d|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])|(([a-zA-Z]|\\\\d|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])([a-zA-Z]|\\\\d|-|\\\\.|_|~|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])*([a-zA-Z]|\\\\d|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])))\\\\.)+(([a-zA-Z]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])|(([a-zA-Z]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])([a-zA-Z]|\\\\d|-|\\\\.|_|~|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])*([a-zA-Z]|[\\\\u00A0-\\\\uD7FF\\\\uF900-\\\\uFDCF\\\\uFDF0-\\\\uFFEF])))\\\\.?$\",\"message\":\"Please enter a valid e-mail address to continue.\",\"validationCssClass\":null,\"additionalAttributes\":null}}]},{\"targetElementName\":\"__field_167911\",\"targetElementId\":\"f2ff8ed1-84cb-4f24-89c7-0f62be229859\",\"validators\":[{\"type\":\"EPiServer.Forms.Samples.Implementation.Validation.RecaptchaValidator\",\"description\":null,\"model\":{\"message\":\"Invalid reCAPTCHA value, please try again.\",\"validationCssClass\":null,\"additionalAttributes\":null}}]}]"
),
// Steps information for driving multiple-step Forms.
StepsInfo: {
Steps: [{
"index": 0,
"attachedUrl": "",
"dependField": null,
"dependCondition": null,
"isActive": true,
"attachedContentLink": "",
"dependValue": "",
"elementName": "__field_",
"guid": "00000000-0000-0000-0000-000000000000"
}]
},
FieldsExcludedInSubmissionSummary: [],
ElementsInfo: JSON.parse(
"{\"__field_167897\":{\"type\":\"EpiserverBH.Models.Blocks.BauschPAP.PAPCustomTextboxElementBlock\",\"friendlyName\":\"Which dry eye symptoms bother you?\",\"customBinding\":false},\"__field_167898\":{\"type\":\"EpiserverBH.Models.Blocks.BauschPAP.PAPCustomTextboxElementBlock\",\"friendlyName\":\"How often do you experience these symptoms?\",\"customBinding\":false},\"__field_167900\":{\"type\":\"EpiserverBH.Models.Blocks.BauschPAP.PAPCustomTextboxElementBlock\",\"friendlyName\":\"How are you currently treating your dry eyes?\",\"customBinding\":false},\"__field_167901\":{\"type\":\"EpiserverBH.Models.Blocks.BauschPAP.PAPCustomTextboxElementBlock\",\"friendlyName\":\"When do your dry eye symptoms bother you?\",\"customBinding\":false},\"__field_167902\":{\"type\":\"EpiserverBH.Models.Blocks.BauschPAP.PAPCustomTextboxElementBlock\",\"friendlyName\":\"Are you interested in talking with an eye doctor about a prescription treatment that may provide symptom relief?\",\"customBinding\":false},\"__field_167886\":{\"type\":\"EpiserverBH.Models.Blocks.CustomTextboxElementBlock\",\"friendlyName\":\"First Name\",\"customBinding\":false},\"__field_167887\":{\"type\":\"EpiserverBH.Models.Blocks.CustomTextboxElementBlock\",\"friendlyName\":\"Last Name\",\"customBinding\":false},\"__field_167888\":{\"type\":\"EpiserverBH.Models.Blocks.CustomTextboxElementBlock\",\"friendlyName\":\"E-mail\",\"customBinding\":false},\"__field_167895\":{\"type\":\"EpiserverBH.Models.Blocks.BauschPAP.PAPCustomChoiceElementBlock\",\"friendlyName\":\"Policy(2)\",\"customBinding\":false},\"__field_167896\":{\"type\":\"EPiServer.Forms.Implementation.Elements.ParagraphTextElementBlock\",\"friendlyName\":\"Previous-btn\",\"customBinding\":false},\"__field_167892\":{\"type\":\"EpiserverBH.Models.Blocks.CustomSubmitButtonElementBlock\",\"friendlyName\":\"Get Your Personalized Guide\",\"customBinding\":false}}"
),
DataSubmitController: "/EPiServer.Forms/DataSubmit",
};
/// TECHNOTE: Calculation at FormInfo level, and these values will be static input for later processing.
workingFormInfo.StepsInfo.FormHasNoStep_VirtualStepCreated = true; // this FLAG will be true, if Editor does not put any FormStep. Engine will create a virtual step, with empty GUID
workingFormInfo.StepsInfo.FormHasNothing = false; // this FLAG will be true if FormContainer has no element at all
workingFormInfo.StepsInfo.AllStepsAreNotLinked = true; // this FLAG will be true, if all steps all have contentLink= ="" (emptyString)
})();
</script>
<input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormGuid" value="d9d9a563-8c53-4fd8-822d-1d82aa0bc2ef" data-f-type="hidden" autocomplete="off">
<input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormHostedPage" value="167685" data-f-type="hidden" autocomplete="off">
<input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormLanguage" value="en" data-f-type="hidden" autocomplete="off">
<input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormCurrentStepIndex" value="0" data-f-type="hidden" autocomplete="off">
<input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormSubmissionId" value="" data-f-type="hidden" autocomplete="off">
<div class="Form__Status">
<div role="status" class="Form__Status__Message hide" data-f-form-statusmessage="">
</div>
</div>
<div data-f-mainbody="" class="Form__MainBody">
<section id="__field_" data-f-type="step" data-f-element-name="__field_" class="Form__Element FormStep Form__Element--NonData " data-f-stepindex="0" data-f-element-nondata="">
<!-- Each FormStep groups the elements below it til the next FormStep -->
<div class="quiz1 d-none">
<div class="Form__Element FormTextbox" data-f-element-name="__field_167897" data-f-type="textbox">
<div class="">
<label for="6351d663-922b-44bc-96f5-e89bedb2acb2" class="Form__Element__Caption ">Which dry eye symptoms bother you?</label>
</div>
<div class="">
<input name="__field_167897" id="6351d663-922b-44bc-96f5-e89bedb2acb2" type="text" class="FormTextbox__Input " aria-describedby="__field_167897_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off"
maxlength="100">
</div>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167897" data-f-validationerror="" id="__field_167897_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="quiz2 d-none">
<div class="Form__Element FormTextbox" data-f-element-name="__field_167898" data-f-type="textbox">
<div class="">
<label for="c8b8b5d3-38d1-4eef-bf22-abbf456a4ffd" class="Form__Element__Caption ">How often do you experience these symptoms?</label>
</div>
<div class="">
<input name="__field_167898" id="c8b8b5d3-38d1-4eef-bf22-abbf456a4ffd" type="text" class="FormTextbox__Input " aria-describedby="__field_167898_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off"
maxlength="100">
</div>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167898" data-f-validationerror="" id="__field_167898_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="quiz3 d-none">
<div class="Form__Element FormTextbox" data-f-element-name="__field_167900" data-f-type="textbox">
<div class="">
<label for="7dedea5d-fc49-4cf7-94e9-7e5006894d55" class="Form__Element__Caption ">How are you currently treating your dry eyes?</label>
</div>
<div class="">
<input name="__field_167900" id="7dedea5d-fc49-4cf7-94e9-7e5006894d55" type="text" class="FormTextbox__Input " aria-describedby="__field_167900_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off"
maxlength="100">
</div>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167900" data-f-validationerror="" id="__field_167900_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="quiz4 d-none">
<div class="Form__Element FormTextbox" data-f-element-name="__field_167901" data-f-type="textbox">
<div class="">
<label for="f685ae17-6b0c-45a6-9f65-a64084c9ac78" class="Form__Element__Caption ">When do your dry eye symptoms bother you?</label>
</div>
<div class="">
<input name="__field_167901" id="f685ae17-6b0c-45a6-9f65-a64084c9ac78" type="text" class="FormTextbox__Input " aria-describedby="__field_167901_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off"
maxlength="100">
</div>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167901" data-f-validationerror="" id="__field_167901_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="quiz5 d-none">
<div class="Form__Element FormTextbox" data-f-element-name="__field_167902" data-f-type="textbox">
<div class="">
<label for="68975201-ebb1-494f-82a1-7b9c9e2223e9" class="Form__Element__Caption ">Are you interested in talking with an eye doctor about a prescription treatment that may provide symptom relief?</label>
</div>
<div class="">
<input name="__field_167902" id="68975201-ebb1-494f-82a1-7b9c9e2223e9" type="text" class="FormTextbox__Input " aria-describedby="__field_167902_desc" placeholder="" data-f-datainput="" aria-invalid="false" autocomplete="off"
maxlength="100">
</div>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167902" data-f-validationerror="" id="__field_167902_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="Form-group q-firstname">
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_167886" data-f-type="textbox"> <label for="36d0a5d3-427d-4a96-983e-9c315a5e600f" class="Form__Element__Caption form-label">First Name</label>
<input name="__field_167886" id="36d0a5d3-427d-4a96-983e-9c315a5e600f" type="text" class="FormTextbox__Input form-control" aria-describedby="__field_167886_desc" placeholder="Please Specify" required="" aria-required="true"
data-f-datainput="" aria-invalid="false" autocomplete="off" maxlength="100">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167886" data-f-validationerror="" id="__field_167886_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="Form-group q-lastname">
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_167887" data-f-type="textbox"> <label for="42f14bd1-b20a-42c2-b23f-e4483533cb08" class="Form__Element__Caption form-label">Last Name</label>
<input name="__field_167887" id="42f14bd1-b20a-42c2-b23f-e4483533cb08" type="text" class="FormTextbox__Input form-control" aria-describedby="__field_167887_desc" placeholder="Please Specify" required="" aria-required="true"
data-f-datainput="" aria-invalid="false" autocomplete="off" maxlength="100">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167887" data-f-validationerror="" id="__field_167887_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="Form-group q-email">
<div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_167888" data-f-type="textbox"> <label for="9b9dfaed-affb-4897-b4f7-633e4aec550f" class="Form__Element__Caption form-label">E-mail Address</label>
<input name="__field_167888" id="9b9dfaed-affb-4897-b4f7-633e4aec550f" type="text" class="FormTextbox__Input form-control" aria-describedby="__field_167888_desc" placeholder="Please Specify" required="" aria-required="true"
data-f-datainput="" aria-invalid="false" autocomplete="off" maxlength="100">
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167888" data-f-validationerror="" id="__field_167888_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="form-check q-policy">
<div aria-invalid="false" class="Form__Element FormChoice" data-f-element-name="__field_167895" data-f-type="choice" id="f343f641-5254-44ec-8ab3-d72456472145">
<div class="form-check-label q-policy-label">
<label>
<input type="checkbox" id="f343f641-5254-44ec-8ab3-d72456472145_0" name="__field_167895" value="TRUE" class="form-check-input q-policy-input FormChoice__Input FormChoice__Input--Checkbox" data-f-datainput="" maxlength="100">
<p class="quiz-ext-policy">By clicking, you agree that you are 18 years or older and agree to the <span class="text-nowrap">Bausch + Lomb</span>
<a class="policy-links" tabindex="1" href="https://www.bausch.com/terms/" rel="noopener noreferrer" target="_blank" title="Terms of Use">Terms of Use</a>. You understand that the information you provided will be used in accordance
with the <span class="text-nowrap">Bausch + Lomb</span> <a class="display7 underline text-sky" tabindex="1" href="https://www.bausch.com/privacy/" rel="noopener noreferrer" target="_blank" title="Privacy Policy">Privacy Policy</a>,
including to provide you with marketing information, offers, and promotions, and to contact you for opinions regarding products, programs, and services. <strong><span class="text-nowrap">Bausch + Lomb</span> may also show you relevant
health-related advertisements when you visit other websites. To learn about our interest-based ads,</strong>
<a href="https://www.bausch.com" class="underline display7 text-sky" target="_blank" tabindex="1" rel="noopener noreferrer">click here</a>. You understand that unless you unsubscribe by calling
<a class="tell" href="tel:1-888-669-6682">1-888-669-6682</a> or clicking unsubscribe in a promotional e-mail, your consent will remain valid.</p> By clicking, you agree that you are 18 years or older and agree to the Bausch & Lomb
Terms of Use. You understand that the information you provided will be used in accordance with the Bausch & Lomb Privacy Policy, including to provide you with marketing information, offers, and promotions, and to contact you for
opinions regarding products, programs, and services. Bausch & Lomb may also show you relevant health-related advertisements when you visit other websites. To learn about our interest-based ads, click here. You understand that unless
you unsubscribe by calling 1-888-669-6682 or clicking unsubscribe in a promotional e-mail, your consent will remain valid.
</label>
</div>
<span class="Form__Element__ValidationError" data-f-linked-name="__field_167895" data-f-validationerror="" id="__field_167895_desc" role="alert" style="display:none"></span>
</div>
</div>
<div class="Form__Element FormParagraphText Form__Element--NonData" data-f-element-name="__field_167896" data-f-element-nondata="">
<div id="e0c5e563-ff9d-428f-8f8e-181999cad1d1">
<p class="previous"><a class="prevQues form-prevQues" rel="noopenner noreferrer" tabindex="1">Previous Question</a></p>
</div>
<div id="e0c5e563-ff9d-428f-8f8e-181999cad1d1__OriginalText" class="Form__Original__ParagraphText">
<p class="previous"><a class="prevQues form-prevQues" rel="noopenner noreferrer" tabindex="1">Previous Question</a></p>
</div>
</div>
<div class="submit-btn">
<button id="fef944d8-faa5-4269-9f9d-0b0d246c76b2" name="submit" type="submit" value="fef944d8-faa5-4269-9f9d-0b0d246c76b2" data-f-is-finalized="false" data-f-is-progressive-submit="true" data-f-type="submitbutton"
data-f-element-name="__field_167892" class="Form__Element FormExcludeDataRebind FormSubmitButton btn btn-warning "> Get Your Personalized Guide</button>
</div>
<input name="__field_167903" id="d891f347-c21e-4dce-ac69-9857410addd0" type="hidden" value="4bde1354-f4b6-44ab-81e9-499834165f3d" class="Form__Element FormHidden FormHideInSummarized" data-f-type="hidden" maxlength="100">
<input name="__field_167905" id="94418630-0158-4cd0-a326-f8e606234f3e" type="hidden" value="Xiidra-DTC-Quiz-Form" class="Form__Element FormHidden FormHideInSummarized" data-f-type="hidden" maxlength="100">
<input name="__field_167906" id="a8a8f8b3-4355-43c2-a20b-55e2e8968acb" type="hidden" value="https://xiidra.com/" class="Form__Element FormHidden FormHideInSummarized" data-f-type="hidden" maxlength="100">
<input name="__field_167908" id="69a49af0-7232-4b15-ac59-2475ac2afec4" type="hidden" value="TRUE" class="Form__Element FormHidden FormHideInSummarized" data-f-type="hidden" maxlength="100">
<input name="__field_167907" id="bc3a40a6-07c5-4015-9737-14ec586284bd" type="hidden" value="Pharma" class="Form__Element FormHidden FormHideInSummarized" data-f-type="hidden" maxlength="100">
<input name="__field_167910" id="3ac7b91a-3017-4db8-8cf5-e86a087d810f" type="hidden" value="TRUE" class="Form__Element FormHidden FormHideInSummarized" data-f-type="hidden" maxlength="100">
<div id="f2ff8ed1-84cb-4f24-89c7-0f62be229859" class="Form__Element Form__CustomElement FormRecaptcha" data-epiforms-element-name="__field_167911" data-epiforms-sitekey="6LcsP2IpAAAAABBYxU3yaPWXW30r3K2rLW4ZC3jn">
<span role="alert" aria-live="polite" data-epiforms-linked-name="__field_167911" class="Form__Element__ValidationError" style=" display:none;">
</span>
</div>
</section>
</div>
<input name="__RequestVerificationToken" type="hidden" value="CfDJ8DQ6wjGuRnVOg-fn2NihgmkMK7EWJMujwa97eyw_iHEKhOP9-7TtAJ7bBOmKctYMARMKkdZ82YQRkzySOKMIOjTRDFaVanR-o-P806NihwC_Rr968ruGhNX-afKATQ4T4VWS-HirfpCAEzEqkv-XqkA">
</form>Text Content
* This site is intended for US audiences only. * Patient Information * Full Prescribing Information * * Important Safety Information * Healthcare Professionals Site Get $0 Co-Pay§ * This site is intended for US audiences only. * Patient Information * Full Prescribing Information * * Important Safety Information * Healthcare Professionals Site Get $0 Co-Pay§ * Home * Chronic Dry Eye * About Xiidra * Find a Doctor * Savings & Support * Xiidra Insider * This site is intended for US audiences only. * Patient Information * Full Prescribing Information * * Important Safety Information * Healthcare Professionals Site Get $0 Co-Pay§ Exciting news for patients! Xiidra is covered for approx 90%* of patients across Commercial and Medicare prescription plans! * Find a doctor "I FOUND LASTING DRY EYE SYMPTOM RELIEF WITH XIIDRA®."† ASK YOUR EYE DOCTOR ABOUT XIIDRA. Read about XiidraSee Ken’s Story *Based on data from February 2024. Up to 71% of Medicare Part D and 94% of commercial patients may be covered. †Xiidra may provide lasting symptom relief for some patients with continued twice-daily use. In clinical studies, Xiidra reduced symptoms of eye dryness at 2 weeks in 2 out of 4 studies, with improvements observed at 6 and 12 weeks in all 4 studies. XIIDRA MAY PROVIDE LASTING SYMPTOM RELIEF IN AS LITTLE AS 2 WEEKS† In clinical studies, Xiidra was shown to, on average: REDUCE DRY EYE SYMPTOMS AT 6 AND 12 WEEKS REDUCE SIGNS OF DRY EYE AT (the things your doctor can assess) WEEK 12 in some patients (in 3 out of 4 studies) †Xiidra may be providing lasting symptom relief for some patients with continued twice-daily use. In clinical studies, Xiidra reduced symptoms of eye dryness at 2 weeks in 2 out of 4 studies, with improvements observed at 6 and 12 weeks in all 4 studies. THE DRY EYE QUIZ Take the next step to see if your symptoms may be associated with chronic dry eye by answering a few questions and discussing with your doctor. WHICH DRY EYE SYMPTOMS BOTHER YOU? (Please select all that apply) ACHY DRY STINGING BURNING IRRITATING LIKE SOMETHING'S IN MY EYE ITCHY NONE OF THESE Please select at least one option to continue. Next HOW OFTEN DO YOU EXPERIENCE THESE SYMPTOMS? EVERY DAY A FEW TIMES A WEEK ONCE OR TWICE A WEEK Previous Question Please answer all the prompts. HOW ARE YOU CURRENTLY TREATING YOUR DRY EYES? OVER-THE-COUNTER EYE DROPS OR ARTIFICIAL TEARS XIIDRA® NOTHING CURRENTLY OTHER THERAPY A PRESCRIPTION TREATMENT (NOT XIIDRA®) Please answer all the prompts. Previous Question WHEN DO YOUR DRY EYE SYMPTOMS BOTHER YOU? (Please select all that apply) IN DRY WEATHER WHEN LOOKING AT SCREENS FOR A LONG TIME WHEN YOU WEAR CONTACT LENSES OTHER Please select at least one option to continue. Previous Question Next ARE YOU INTERESTED IN TALKING WITH AN EYE DOCTOR ABOUT A PRESCRIPTION TREATMENT THAT MAY PROVIDE SYMPTOM RELIEF? YES NO MAYBE Previous Question Please answer all the prompts. PLEASE SHARE A LITTLE INFORMATION ABOUT YOURSELF BELOW TO GET YOUR QUIZ RESULTS AND PERSONALIZED DISCUSSION GUIDE. Which dry eye symptoms bother you? How often do you experience these symptoms? How are you currently treating your dry eyes? When do your dry eye symptoms bother you? Are you interested in talking with an eye doctor about a prescription treatment that may provide symptom relief? First Name Last Name E-mail Address By clicking, you agree that you are 18 years or older and agree to the Bausch + Lomb Terms of Use. You understand that the information you provided will be used in accordance with the Bausch + Lomb Privacy Policy, including to provide you with marketing information, offers, and promotions, and to contact you for opinions regarding products, programs, and services. Bausch + Lomb may also show you relevant health-related advertisements when you visit other websites. To learn about our interest-based ads, click here. You understand that unless you unsubscribe by calling 1-888-669-6682 or clicking unsubscribe in a promotional e-mail, your consent will remain valid. By clicking, you agree that you are 18 years or older and agree to the Bausch & Lomb Terms of Use. You understand that the information you provided will be used in accordance with the Bausch & Lomb Privacy Policy, including to provide you with marketing information, offers, and promotions, and to contact you for opinions regarding products, programs, and services. Bausch & Lomb may also show you relevant health-related advertisements when you visit other websites. To learn about our interest-based ads, click here. You understand that unless you unsubscribe by calling 1-888-669-6682 or clicking unsubscribe in a promotional e-mail, your consent will remain valid. Previous Question Previous Question Get Your Personalized Guide ELIGIBLE PATIENTS WITH COMMERCIAL INSURANCE CAN PAY AS LITTLE AS $0 FOR XIIDRA§ WITH A XIIDRA SAVINGS CARD. REGISTER ONLINE My Savings Program * Find a doctor Show More WHAT IS XIIDRA? Xiidra (lifitegrast ophthalmic solution) 5% is a prescription eye drop used to treat the signs and symptoms of dry eye disease. IMPORTANT SAFETY INFORMATION Do not use Xiidra if you are allergic to any of its ingredients. Seek medical care immediately if you get any symptoms of an allergic reaction. The most common side effects of Xiidra include eye irritation, discomfort or blurred vision when the drops are applied to the eyes, and an unusual taste sensation. * Find a doctor Show Less WHAT IS XIIDRA? Xiidra (lifitegrast ophthalmic solution) 5% is a prescription eye drop used to treat the signs and symptoms of dry eye disease. IMPORTANT SAFETY INFORMATION Do not use Xiidra if you are allergic to any of its ingredients. Seek medical care immediately if you get any symptoms of an allergic reaction. The most common side effects of Xiidra include eye irritation, discomfort or blurred vision when the drops are applied to the eyes, and an unusual taste sensation. To help avoid eye injury or contamination of the solution, do not touch the container tip to your eye or any surface. If you wear contact lenses, remove them before using Xiidra and wait for at least 15 minutes before placing them back in your eyes. It is not known if Xiidra is safe and effective in children under 17 years of age. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. WHAT IS XIIDRA? Xiidra (lifitegrast ophthalmic solution) 5% is a prescription eye drop used to treat the signs and symptoms of dry eye disease. For additional safety information, click here for Full Prescribing Information and Patient Information and discuss with your doctor. §Limitations apply. Eligible, commercially insured patients using the Xiidra Savings Card pay $0 for their first prescription of Xiidra. $0 first fill available for prescriptions up to 90 days. After the first fill, eligible, commercially insured patients may pay as little as $0 for prescriptions of Xiidra. The copay card can be used once every 21 days for 30-day fill and 63 days for 90-day fill. Offer not valid under Medicare, Medicaid, or any other federal or state program. Bausch + Lomb reserves the right to rescind, revoke, or amend this program without notice. See complete Terms & Conditions for details. YOU ARE NOW LEAVING XIIDRA.COM You are now leaving the Xiidra® site and moving to an external website independently operated and not managed by Bausch + Lomb. Bausch + Lomb assumes no responsibility for the site. CONTINUE CANCEL EXCITING NEWS FOR PATIENTS! XIIDRA IS COVERED FOR APPROX 90%* OF PATIENTS ACROSS COMMERCIAL AND MEDICARE PRESCRIPTION PLANS. *Based on data from February 2024. Up to 71% of Medicare Part D and 94% of commercial patients may be covered. GET CO-PAY CARD CONTACT US PRIVACY POLICY LEGAL NOTICE SITE MAP HEALTHCARE PROFESSIONALS ©2024 Bausch + Lomb. XDR.0030.USA.24 (v3) All information and materials on this site pertain to the U.S. only, unless otherwise indicated. * Unsubscribe * Do Not Sell or Share My Personal Information * Do Not Target * Limit the Use of My Sensitive Personal Information