Efficacy of topical cyclosporine A in the treatment of severe trachomatous dry eye

Purpose:  The purpose of this study was to evaluate the efficacy of topical cyclosporine A (CsA) treatment in patients with severe trachomatous dry eye.
Methods:  Sixty-four severe trachomatous dry eye patients who had undergone Schirmer testing with topical anaesthetic measured 5 mm or less and a tear film break-up time (TFBUT) of 5 s or less were included in the study. Thirty-two patients were treated with CsA 0.05% ophthalmic emulsion twice daily and concomitant five times daily non-preserved artificial tear, and the other 32 patients who were designated as the control group received vehicle emulsion twice daily and non-preserved artificial tear five times daily. Pretreatment and post-treatment evaluations included subjective assessment of the patients (total symptoms scores and ocular surface disease index OSDI] scores), Schirmer testing with topical anaesthesia, TFBUT, rose Bengal and fluorescein staining scores, conjunctival impression cytological scoring and goblet cell counting.
Results:  Following 6 months of CsA treatment, the differences between the pretreatment and post-treatment test results including total symptoms scores and OSDI scores, the rose Bengal and fluorescein staining scores, TFBUT values, and the Schirmer testing measurements were found to be statistically significant. Impression cytology also showed improvement of squamous metaplasia in 26 patients (81.25%) and increase in goblet cell density in 23 patients (71.88%).
Conclusions:  Topical CsA was effective in the treatment of severe trachomatous dry eye, yielding improvements in both objective and subjective measurements with a safety profile.