High-frequency Topical Cyclosporine 0.05% in the Treatment of Severe Dry Eye Refractory to Twice-daily Regimen

Abstract

Purpose The purpose of this study was to report the efficacy of topical cyclosporine 0.05% at a frequency of 3 to 4 times daily in severe dry eye disease. Methods We retrospectively identified a cohort of patients with severe dry eye disease who had shown inadequate response to at least a 4-month course of treatment with twice-daily use of topical cyclosporine 0.05% but who showed significant improvement to more frequent dosing. Results Twenty-two patients, including 13 patients with ocular graft versus host disease and 9 patients with primary or secondary Sjögren’s syndrome, were included. After a minimum of a 2-month course of treatment with more frequent dosing of cyclosporine 0.05% (3 times a day in 7 patients and 4 times a day in 15 patients), overall dry eye symptoms were improved in 15 (68.2%) patients (9 patients with ocular graft versus host disease and 6 patients with Sjögren’s syndrome). Mean corneal fluorescein staining scores (National Eye Institute scale of 0–15) improved (decreased) from the baseline (precyclosporine use) by −3.5 (range, 0 to −7) in patients with ocular graft versus host disease (P ≤ 0.0008) and −2.8 (range, 0 to −5) in patients with Sjögren’s syndrome (P ≤ 0.001). After treatment with high-frequency use of cyclosporine 0.05%, the global physician assessment of dry eye status was favorable (improved) in 16 (72.7%) patients. Three (13.6%) patients reported new-onset symptoms of burning or irritation with the use of high-frequency dosing of topical cyclosporine. No other associated adverse effect was reported. Conclusion These data suggest that patients with severe dry eye may require more frequent dosing of topical cyclosporine 0.05% than twice daily.