title: Effects of topical cyclosporine a plus artificial tears versus artificial tears treatment on conjunctival goblet cell density in dysfunctional tear syndrome.
abstract: OBJECTIVE
  The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS).
  
  
  METHODS
  Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group.
  
  
  RESULTS
  In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (P<0.001 for all). In the control group, corneal fluorescein staining (P<0.001) and conjunctival lissamine green staining (P=0.014) improved, but BUT and Schirmer scores did not change significantly after treatment. At the end of the 4-month follow-up, the study group demonstrated statistically significantly better BUT (P=0.020), Schirmer scores (P=0.002), goblet cell density (P=0.006), corneal fluorescein staining (P=0.003), and conjunctival lissamine green staining (P=0.017) scores than did the control group.
  
  
  CONCLUSIONS
  Topical cyclosporine A and artificial tears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health.
authors.affiliation: Department of Ophthalmology, Niğde State Hospital, Niğde, Turkey.
authors.forename: Elvan
authors.initials: E
authors.lastname: Demiryay
authors.forename: Volkan
authors.initials: V
authors.lastname: Yaylali
authors.forename: Ebru Nevin
authors.initials: EN
authors.lastname: Cetin
authors.forename: Cem
authors.initials: C
authors.lastname: Yildirim
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D002452:Cell Count; D003228:Conjunctiva / Q000187:drug effects* / Q000473:pathology; D016572:Cyclosporine / Q000008:administration & dosage*; D015352:Dry Eye Syndromes / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D020397:Goblet Cells / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000627:therapeutic use*; D013666:Tears / Q000502:physiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D009883:Ophthalmic Solutions; D016572:Cyclosporine