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.
Roberts
Calvin W
CW
Department of Ophthalmology, Weill Medical College of Cornell University, New York, NY, USA. croberts@med.cornell.edu
Carniglia
Patricia E
PE
Brazzo
Brian G
BG
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