Supplements Management and Pharmacoeconomics of Dry Eye Disease: The Role of Cyclosporine
Management of Dry Eye
• Topical corticosteroids. Although effective, these agents are generally recommended only for short-term use because prolonged use may result in AEs including ocular infection, glaucoma, and cataracts.
• Oral tetracyclines. Based on limited evidence, oral tetracyclines have been used off-label to treat DED, primarily DED associated with ocular rosacea.
• Topical cyclosporine. Topical cyclosporine is currently the only pharmacologic treatment that is FDA approved specifically for DED. Although its onset of action is relatively slow, it is safe for long-term use and appears to be disease-modifying rather than merely palliative. The most common AE is transient burning or stinging. Because blood levels are negligible even after long-term use, the risk of systemic toxicity is minimal.
Topical NSAIDs have been used off-label in DED; however, their use is controversial because they can promote corneal melting in patients with a compromised ocular surface. Some experts feel that they have no role in DED therapy.
Treatment selection is guided primarily by DED severity. ITF guidelines, published in 2006, proposed a DED severity classification based on clinical signs and symptoms. The ITF also developed a treatment algorithm according to severity grading and the presence or absence of lid margin disease. In 2007 the DEWS Management and Therapy Subcommittee published treatment recommendations based on a modified form of the ITF severity classification.
Author Affiliations: From Georgetown and George Washington Universities, and OcuSense, Inc, Washington, DC.
Funding Sources: The research and manuscript were funded by Allergan, Inc.
Author Disclosures: The author reports being a consultant for Alcon, Allergan, Novagali Pharma, OcuSense, Inc, and SARcode; and being a major stock shareholder for OcuSense, Inc.
Authorship Information: Concept and design, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.
Address Correspondence to: Michael A. Lemp, MD, 4000 Cathedral Avenue, NW #828B, Washington, DC 20016. E-mail: firstname.lastname@example.org.
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