Topical cyclosporine: 'New treatment of choice' for dry eye, surgeon says

DANA POINT, Calif. — Treating dry eye disease with topical cyclosporine "will become the big external disease story for 2003," Peter J. McDonnell, MD, said here at the Sixth Annual Ocular Drug & Surgical Therapy Update Meeting. According to Dr. McDonnell, this revolution in dry eye management evolved from uncovering the root cause of dry eye syndrome.

"Twenty years ago we considered dry eye a tear-volume deficiency where the tear gland was not producing as it ought to," Dr. McDonnell said.

Dry eye is now seen as a more complex immune-based inflammatory condition that alters both quantity and quality of tears, he said. Over the past 10 years, however, researchers have learned there is a T-cell activation effect that occurs as a cursory response of cyclosporine therapy to prevent activation of T lymphocytes.

Trials showed dramatic results first on dogs and then on humans.

"Dogs with severe dry eye such that they would be euthanized, are able with topical cyclosporine to restore a normal tear level. In the conjunctiva where we saw apoptosis, damage, loss and destruction of the cells, and after cyclosporine (Restasis, Allergan) we see restoration of the goblet cells," Dr. McDonnell said.

In treating Sjögren's syndrome, topical cyclosporine worked equally as well as in non-Sjögren's patients without the typical disparity physicians see in other treatment modalities.

"Trials show very clearly that this cyclosporine preparation improves symptoms, including the severe symptom of blurred vision, emphasizing the importance of tear production for the function of the eye," Dr. McDonnell said. "Cyclosporine reduced the need for artificial tears, reduced global severity of the disease and increased tear production 10 ml or more for 15% of patients in Schirmer tests."

The Sixth Annual Ocular Drug & Surgical Therapy Update Meeting is a CME activity sponsored by SLACK Incorporated and supported through an unrestricted grant from Allergan.