Topical cyclosporine yields best outcomes for mild to moderate dry eye

Eur J Ophthalmol. 2010;20:675-679.

Topical cyclosporine A proved most effective in treating signs and symptoms of mild to moderate dry eye syndrome, a study showed.

"Conventional therapy of dry eye syndrome includes artificial tear replacement and measures to preserve the tear volume," the study authors wrote. "Additionally, some studies revealed that cyclosporine A, being an immunomodulatory agent, breaks the cell-mediated inflammatory cascade and reduces dry eye symptoms."

The study included 40 eyes of 40 patients with a mean age of 57.1 years. Investigators assessed Schirmer test scores, tear breakup time, Ocular Surface Disease Index (OSDI) scores and goblet cell density before and after 6 months of treatment with topical cyclosporine A.

Dry eye disease was graded on a 4-point scale based on biomicroscopic and clinical findings: 0 (normal); 1 (symptoms such as burning, itching and epiphora); 2 (corneal staining, punctate keratitis and filaments in addition to symptoms); and 3 (corneal scarring and neovascularization in addition to grade 2 signs).

At baseline, 12 patients had grade 1 dry eye disease, 18 patients had grade 2 disease and 10 patients had grade 3 disease.

The mean Schirmer test value increased from 3.2 mm at baseline to 8.4 mm after 6 months. Mean tear breakup time increased from 4.4 seconds at baseline to 11.8 seconds after 6 months. OSDI scores improved from 30 before treatment to 21.3. Improvement in all three values was statistically significant (P = .00).

Mean goblet cell density increased from 12.3 preoperatively to 33 at 6 months (P = .04).

The most significant clinical improvement was seen in patients with grade 2 disease; treatment was ineffective in patients with grade 3 disease, the authors reported.

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