Topical Cyclosporine 0.05% and Osmoprotective Lubricating Eye Drops: Role in the Management of DED and Inflammation

24 Dec, 21

Introduction

Reduced aqueous production seen in aqueous?deficient dry eye disease (DED) and/or increased evaporation seen in the evaporative DED may result in tear film hyperosmolarity. Evaporative DED is encountered frequently in clinical practice, though there is a substantial overlap between aqueous?deficient and evaporative DED. Various inflammatory markers including; interleukin-1? (IL-1?), IL-6, matrix metalloproteinases (MMPs), etc. have also been associated with DED. Controlling inflammation has a key role in improving the ocular surface health in DED.

Aim

To evaluate the effect of topical cyclosporine 0.05% and osmoprotective lubricating eye drops in patients with DED with inflammation

Patient Profile

Patients with mild to moderate aqueous deficiency and evaporative dry eye with two or more of the following criteria:
- Ocular Surface Disease Index (OSDI) >12
- Tear break up time (TBUT): 6-10 s
- Schirmer’s test I result: 8–10 mm/5 min
- Ocular surface staining

Methods

Study Design

An open-label prospective study

Assessment

Ocular surface inflammation was assessed by evaluating MMP?9 positivity from tears of the study participants

Treatment Strategy

Patients were prescribed osmoprotective lubricating eye drops four times a day and cyclosporine A 0.05% eye drops twice a day for 6 months.

Efficacy Outcomes

Change in OSDI scores, Schirmer’s test and TBUT
Reduction in ocular surface staining
Reduction in MMP?9 levels

Results

Patients with MMP?9 positivity had a significantly higher OSDI score (mean OSDI score 29.7, P=0.0052) and significantly decreased Schirmer’s test values (P=0.0013).
Six months topical treatment was associated with a significantly improved OSDI scores (mean pre-treatment: 25.7, and mean post-treatment: 15.2, P <0.001) (Fig. 1).

Fig. 1: Change in OSDI score during the study

The proportion of patients who were MMP?9 positive reduced substantially. Of the 75 eyes that tested MMP?9 positive, 70.66% showed significant reduction in MMP?9 levels post-treatment (P < 0.0001).
During the pre-treatment period, 35.85% eyes (n=38 eyes) exhibited corneal staining, the same reduced significantly to 18.87% (n=20 eyes) after 6 months of treatment. TBUT improved from 7.67 to 8.15 s (p=0.06). There was no statistically significant difference in pre-and post-treatment Schirmer’s test results.

Conclusions

Six-month treatment with topical osmoprotective lubricating eye drops and cyclosporine A 0.05% reduced inflammation in patients with DED, as measured by levels of tear MMP?9.
Reduction in inflammation correlated with improved OSDI scores and ocular surface staining.
Topical cyclosporine A 0.05% and osmoprotective lubricants have an important role in the management of DED.

Indian J Ophthalmol 2021;69:3473-7.