Cyclosporine, plugs may be useful in combination

SAN DIEGO – The adjunctive use of cyclosporine and punctal occlusion may be useful to some dry eye patients, according to a study presented here at the American Academy of Optometry meeting Saturday.

“I think we were all very excited when cyclosporine came out, because it is a new way to treat our dry eye patients,” said presenter Patricia Carniglia, OD. “But it’s taken us a while to figure out how it fits into our therapeutic regimens.”

The study was aimed at comparing the usefulness of cyclosporine, punctal occlusion and a combination of the two in treating dry eye.

For this study, 30 dry eye patients were randomized to one of three treatment groups: cyclosporine 0.05% ophthalmic emulsion (Restasis) twice daily, lower-lid punctal plugs (Parasol) or a plugs/cyclosporine combination.

Baseline measurements were taken of tear volume, ocular surface staining and artificial tear usage. These assessments were also made after 1, 3 and 6 months. The study found that all of the above treatments improved Schirmer’s scores by 6 months, with regimens containing plugs favored at 1 and 3 months. At 3 and 6 months, cyclosporine-containing regimens, but not plugs alone, improved rose bengal staining. There was a decrease in artificial tear usage with plug-containing regimens at 1 month, and with all treatments at 3 and 6 months. The greatest overall improvements were yielded through combination therapy, which was more efficacious than plugs alone in decreasing artificial tear usage at 3 and 6 months.

The study concluded that all three regimens effectively treated the condition, and that adjunctive therapy may be useful. Dr. Carniglia described her approach to adjunctive therapy with cyclosporine and plugs.

“We put the plugs in and start the patient on cyclosporine, and for those who feel worse, we take the plugs out,” she said. “For those who feel better, we keep the plugs in.”