Yukoh Yoshida President Senju Pharmaceutical Co., Ltd. 5-8, Hiranomachi 2-chome Chuo-ku, Osaka, 541-0046 Japan Dear Mr. Yoshida:

Exhibit 10.1

Xxxxx Xxxxxxx

President

Senju Pharmaceutical Co., Ltd.

0-0, Xxxxxxxxxxx 0-xxxxx

Xxxx-xx, Xxxxx, 000-0000

Xxxxx

Dear Xx. Xxxxxxx:

In connection with our recent letter regarding changing the terms and conditions of the Bromfenac License Agreement dated March 7, 2002, and amended August 13, 2002 and May 31, 2006, this letter is to further document our mutual agreement to the following additional change.

Senju and ISTA agree that the definition of Territory in the License Agreement is amended to read:

1.02 “Territory” shall mean North America, including the possessions of the United States.”

If you agree to the above, please sign and date this and the duplicate copy of this letter in the space provided below and return one signed copy to us.

Sincerely yours,

/s/ Xxxxxxx Xxxxx, Xx.

Xxxxxxx Xxxxx, Xx.

President and CEO

ISTA Pharmaceuticals, Inc.

Date: December 11, 2009

Agreed to and accepted

/s/ Xxxxx Xxxxxxx

Xxxxx Xxxxxxx

President

Senju Pharmaceutical Co., Ltd.