Study Examines Cyclosporine A as Possible Treatment for Sjögren’s Dry Eye Syndrome

Cyclosporine A treatment improves vision and increases tear production in people with moderate-to-severe dry eye disease, including those with Sjögren’s syndrome, an Egyptian study shows.

The research, “Efficacy and safety of using topical cyclosporine A for treatment of moderate to severe dry eye disease,” was published in the open-access Saudi Journal of Ophtalmology.

Patients with Sjögren’s typically develop chronic dry eyes, which involves inflammation of the glands that secrete tears, reducing tear production. Patients experience a persistent dry, scratchy feeling in the eyes that can lead to damage and a decline in quality of life.

Dry eye syndrome is not exclusive to Sjögren’s patients, but studies suggest that dry eye syndrome in other patients also is caused by chronic inflammation in the ducts and sacs of the lacrimal glands. So, modulating the immune system could be a promising approach for most patients with the condition.

Cyclosporine A (CsA) is a powerful immunosuppressant, blocking the function of T-cells (the cells causing damage to the tear glands) while leaving the bone marrow (where blood cells are generated) unharmed. Importantly, topical CsA has shown promise in treating inflammation at the eye’s surface.

Researchers in Egypt and Saudi Arabia now set out to address if the medicine, delivered topically twice daily, could cure patients with dry eye syndrome instead of just alleviating their symptoms.

Their study included 32 patients (mean age 47, and 87% women) with dry eye syndrome, including 12 with Sjögren’s syndrome, who were attending the ophthalmic outpatient clinic of Research Institute of Ophthalmology, in Cairo.

Two weeks before starting CsA treatment, patients were asked to to stop using all topical eye drops, except for preservative-free tear substitutes, four times daily in each eye.

Patients who finished the washout phase successfully then were given topical CsA for 12 weeks. Treatment was to be administered two times a day, once in the morning and once in the evening, in both eyes. The use of preservative-free tears substitutes also was allowed during the treatment phase.

Patients were evaluated before beginning treatment, and at weeks 4, 8, and 12 during the treatment phase, and then four weeks after stopping CsA.

Results showed that CsA treatment significantly improved patient’s visual acuity and their ability to produce tears. Damage to the eye was also reduced.

Interestingly, patients saw improvements not only throughout the treatment phase, but also four weeks after treatment, suggesting that CsA, indeed, may be curative for these patients.

Also, increases in blood pressure and reduced kidney function — two common side effects of systemic CsA treatment — were not reported in this study.

“Cyclosporine A ophthalmic emulsion 0.05% is the first definitive treatment that targets an underlying pathological mechanism for chronic dry eye: immune-mediated inflammation,” researchers concluded.