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Supplements Management and Pharmacoeconomics of Dry Eye Disease: The Role of Cyclosporine
Prevalence, Burden, and Pharmacoeconomics of Dry Eye Disease
Stephen C. Pflugfelder, MD
Utilization Characteristics of Topical Cycolsporine and Punctal Plugs in a Managed Care Database
Richard G. Fiscella, BS Pharm, MPH; Jeffrey T. Lee, PharmD, FCCP; John G. Walt, MBA; and Todd D. Killian, MBA, MS
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Management of Dry Eye
Michael A. Lemp, MD
Dry Eye Disease: Pathophysiology, Classification, and Diagnosis
Henry D. Perry, MD

Management of Dry Eye

Michael A. Lemp, MD
Although artificial tears can improve DED symptoms and objective findings, there is no evidence that they can resolve the inflammation that accompanies DED. Therefore, anti-inflammatory therapy may be indicated, including:

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: malemp@lempdc.com.

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