Table 1

Proposed therapeutic schema for anti-inflammatory treatment of severe dry eye

At diagnosis∼1 month∼2 months∼6 months
Clinical featuresCorneo-conjunctival epithelial damage ≥3 (Oxford scale)Clinical improvement with reduction of fluorescein corneal scoreMaintaining clinical improvementMaintaining clinical improvement
CorticosteroidsHigh dosage of surface corticosteroids (eg, highly lipophilic molecules) 1 drop four times dailyStart corticosteroid tapering in accordance with clinical improvementHalt corticosteroid useNo corticosteroid use
Cyclosporine AStart treatment with 0.05% eye drops twice dailyContinue cyclosporine A treatmentContinue cyclosporine A treatmentHalt cyclosporine A treatment
Artificial tearsAt least five times dailyContinue use as neededContinue use as neededContinue use as needed

  • Possible recurrence of corneal damage will need further anti-inflammatory treatment with corticosteroids and cyclosporine A.