Oral pilocarpine may be treatment option for severe dry eye

Issue: August 10, 2015

The administration of oral pilocarpine may be a treatment option for severe dry eye, according to a study.

Perspective from David R. Hardten, MD

The prospective study evaluated 28 eyes of 15 patients who were administered 2.5 mg of oral pilocarpine three times a day for the treatment of Sjögren’s syndrome that was complicated by dry eye in which previous conventional conservative treatment failed.

After 3 months of administration, dry eye sensation scores significantly declined from 2.5 ± 0.8 at baseline to 1.7 ± 0.5 at month 3, and eye pain scores significantly decreased from 1.7 ± 0.7 at baseline to 1.0 ± 0.6 at month 3.

Fluorescein staining declined from 2.1 ± 1.3 at baseline to 1.7 ± 1.5 at month 3, which was not significantly different, and rose bengal staining scores significantly decreased from 3.3 ± 1.7 at baseline to 2.3 ± 2.0 at month 3.

Tear film break-up time significantly increased from 2.6 ± 1.3 seconds at baseline to 3.3 ± 1.7 seconds at month 3.

Six patients had adverse reactions within 1 week of treatment; five patients reported stomach discomfort, and four patients reported sweating. The reactions were mild and resolved over the course of the treatment.

“To demonstrate the usefulness in treating dry eye, which requires long-term therapy, it may be necessary to carry out a study in a larger number of subjects for a longer period, and a study to establish a control group may be necessary,” the study authors said. – by Kristie L. Kahl

Disclosure: The authors report no relevant financial disclosures.

Perspective

David R. Hardten, MD

This interesting study brings to the forefront again for us the potential use of oral pilocarpine (trade name Salagen, Eisai Inc., in the U.S.) for patients with dry eye or dry mouth. As the authors point out, the use of oral pilocarpine has been approved for dry eye in patients with Sjögrens outside of Japan for some time now but is not yet approved in Japan. In general in the U.S., either the lack of awareness or the systemic side effects have limited its use for patients with dry eye. What is interesting from the discussion in this study, though, is that only 40% of patients experienced adverse side effects of stomach discomfort or sweating. All were mild in intensity and resolved with continued treatment. I also had been previously unaware of the high rate of these side effects in the placebo group (52%) in previous studies (in previous studies 75% of the treatment group had systemic side effects).

This article highlights the potential for use in patients with dry eye who are very frustrated with ongoing symptoms, and it is worth re-educating yourself on this potential therapy.

David R. Hardten, MD

OSN Cornea/External Disease Section Editor

Disclosures: Hardten reports no relevant financial disclosures.

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Sources/Disclosures

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Source:

Kawakita T, et al. Asia Pac J Ophthalmol. 2015;doi:10.1097/APO.0000000000000040.