Comparison of topical cyclosporine, punctal occlusion, and a combination for the treatment of dry eye.
OBJECTIVE
To compare the efficacy of topical cyclosporine, punctal occlusion, and a combination for the treatment of dry eye.


METHODS
Patients with dry eye (N = 30) seen in a university-affiliated private practice were randomized to 1 of 3 treatments: cyclosporine 0.05% ophthalmic emulsion (RESTASIS) twice daily, lower-lid punctal plugs (PARASOL), or a plugs-cyclosporine combination. Tear volume, ocular surface staining, and artificial tear use were assessed at baseline and 1, 3, and 6 months.


RESULTS
All treatments improved Schirmer scores by 6 months (P < or = 0.005 vs. baseline), with plug-containing regimens favored at 1 and 3 months (P < 0.001 vs. cyclosporine alone). Cyclosporine-containing regimens, but not plugs alone, improved rose bengal staining at 3 and 6 months (P < or = 0.010 vs. baseline). Artificial tear use decreased with plug-containing regimens at 1 month and with all treatments at 3 and 6 months (P < or = 0.005 vs. baseline). Combination therapy produced the greatest overall improvements and was superior to plugs alone in decreasing artificial tear use at 6 months (P = 0.012).


CONCLUSIONS
All 3 regimens effectively treated dry eye. Plug-containing regimens increased wetness initially; cyclosporine appeared to promote long-term ocular surface health. The effects may be additive. Patients with punctal occlusion may benefit from adjunctive cyclosporine.
Department of Ophthalmology, Weill Medical College of Cornell University, New York, NY, USA. croberts@med.cornell.edu
Calvin W
CW
Roberts
Patricia E
PE
Carniglia
Brian G
BG
Brazzo
D000287:Administration, Topical; D000328:Adult; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000008:administration & dosage*; D015352:Dry Eye Syndromes / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005456:Fluorescent Dyes / Q000378:metabolism; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants; D012395:Rose Bengal / Q000378:metabolism; D013666:Tears / Q000378:metabolism; D016896:Treatment Outcome
D005456:Fluorescent Dyes; D012395:Rose Bengal; D016572:Cyclosporine