Perspective
Antiinflammatory therapy for dry eye☆

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Abstract

Purpose

To present evidence establishing the relationship between inflammation and dry eye and supporting the use of antiinflammatory therapy for dry eye.

Design

Analysis of literature.

Methods

Research studies that evaluated inflammation in dry eye pathogenesis and clinical trials of antiinflammatory therapies for dry eye were reviewed.

Results

There is increasing evidence that decreased tear secretion, decreased tear turnover, and desiccation promote inflammation on the ocular surface. An increase in soluble mediators (cytokines and proteases) in the tear fluid, adhesion molecule expression by the conjunctival epithelium, and T-cell infiltration of the conjunctiva have been observed in dry eye patients. This inflammation appears to have a role in the pathogenesis of the ocular surface epithelial disease, termed keratoconjunctivitis sicca (KCS), that develops in dry eye. Clinical improvement of KCS has been observed after therapy with antiinflammatory agents including corticosteroids, cyclosporin and doxycycline. Cyclosporin A emulsion was approved by the Food and Drug Administration as therapy for dry eye. Randomized placebo-controlled FDA clinical trials showed that cyclosporine A was superior to vehicle in stimulating aqueous tear production, decreasing corneal punctuate fluorescein staining, reducing symptoms of blurred vision, and decreasing artificial tear use in patients with KCS. No ocular or systemic toxicity was observed from this medication.

Conclusions

Ocular surface and lacrimal gland inflammation has been identified in dry eye that plays a role in the pathogenesis of KCS. Antiinflammatory therapy has efficacy for treating KCS. Cyclosporin A is the first FDA approved therapy for this indication. It improved signs and symptoms of KCS, and it is safe for long-term use.

Section snippets

Studies support use of antiinflammatory therapy for dry eye

A common feature of all dry eye conditions is an unstable tear film that can be identified by a rapid tear fluorescein break-up time or by noninvasive techniques, such as computerized videokeratoscopy.7, 8 This tear film instability develops from disease or dysfunction of one or more components of the integrated lacrimal functional unit, which consists of ocular surface afferent sensory nerves, efferent autonomic and motor nerves that stimulate tear secretion and blinking, and the

Supplementary files

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    Biosketches and/or additional material at www.ajo.com doi:10.1016/j.ajo.2003.10.036

    This study was supported by National Eye Institute Grant EY11915, and by an unrestricted grant from Research to Prevent Blindness, Inc, the Oshman Foundation, and the William Stamps Farish Fund.

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