Ocular Rosacea/ Dry Eye News
A dry eye Supplement called HydroEye is available here. A couple people from the rosacea group may have tried it here. I will try to email them for a review.
Theratears is an excellent artificial tear drop in my opinion but there are many others. GenTeal gel by CibaVision is interesting as well & they make important Eye Scrub products. Drugstore.com is a convenient online store to purchase these products & any prescribed oral antibiotics.
Topical cyclosporine looks very promising for the treatment of dry eye. I am most surprised by the lack of reported side effects even with long term use as it is an immunosuppressant (hopefully no degenerative steroid or toxic side effects) but dry eye may just represent a state of an excessive immune-based inflammation. Efficacy & clinical experience have led many Corneal Specialists to use pharmacy-formulated CsA to treat KCS and its complications until it will be mass-marketed.
Topical cyclosporine targets dry eye disease.(Brief Article)
Author/s: Cheryl Guttman
Issue: June 15, 2000
Reviewed by Peter J. McDonnell, MD
FORT LAUDERDALE, FL--Immune-based inflammation plays a role in the pathophysiology of dry eye related to Sjogren's syndrome as well as in non-Sjogren's keratoconjunctivitis sicca
(KCS), so topical cyclosporine is rational therapy for both disorders, according to Peter J. McDonnell, MD.
"This is the big external disease story of 2000. Previously, I perceived inflammation as a causal factor of dry eye only in patients with Sjogren's syndrome, and consequently it was only for these patients where treatment with an immunomodulatory agent made sense," said Dr. McDonnell, Irving H. Leopold Professor and Chair, Doheny Eye Institute, at the annual meeting of the Association for Research in Vision and Ophthalmology here.
"The fact that an inflammatory process involving the lacrimal gland and ocular surface also mediates non-Sjogren's dry eye was news to me, but indicates the need to reorient our thinking about management," he said.
When topical cyclosporine becomes available, ophthalmologists may need to spend time educating their primary-care colleagues, who are often the first to see dry eye patients, he said.
"To date, with no specific therapy available to offer these individuals, there was no advantage to getting them in to see the ophthalmologist early on. However, having the opportunity to treat with a drug that can interrupt the inflammatory process and reduce disease severity, it will no longer make sense simply to send them home with some artificial tears," explained Dr. McDonnell.
"Rather, it will be important that primary-care practitioners become able to identify patients who may be appropriate candidates for cyclosporine, so that they can refer these individuals for ophthalmologic evaluation," he continued.
Dry eye, regardless of whether it is associated with a systemic autoimmune disorder, is a lymphocyte-mediated inflammatory disease, according to research performed in the canine dry eye model as well as findings from conjunctival biopsy specimens of humans. In the clinical specimens, lymphocytes have been identified in the conjunctival substantia propria of both Sjogren's and non-Sjogren's patients, said Dr. McDonnell.
Inflammatory markers noted
In addition, a European multicenter cyclosporine study showed inflammatory markers, HLA-DR, CD40, and CD40 ligand, were strongly expressed in both Sjogren's and non-Sjogren's eyes. Flow cytometric analyses of impression cytology specimens were obtained from the superior bulbar conjunctiva of the participants, reported A. C. Baudouin, MD, PhD, Ambrose Parc Hospital, Boulogne, France.
Topical cyclosporine represents an effective therapeutic choice for moderate-to-severe dry eye, regardless of its underlying etiology, according to results of domestic and European multicenter trials.
This modality provided symptomatic relief, reversed objective signs of dry eye, and reduced inflammatory markers in both patients with Sjogren's syndrome and non-Sjogren's dry eye, he continued.
Topical cyclosporine was investigated in two, identically designed, double-masked, parallel group trials in the United States (Sall K, et al. Ophthalmology 2000;107:631-9). Those phase III studies enrolled 877 patients with moderate to severe dry eye disease who were randomly assigned to receive 6 months of treatment with cyclosporine 0.05% or 0.1% or vehicle.
Compared with control, cyclosporine was associated with significantly greater improvements in corneal staining and categorized Schirmer values. In addition, it was significantly favored in analyses of blurred vision, need for concomitant artificial tears, and the physician's evaluation of dry eye disease treatment.
Investigations performed on superficial conjunctival epithelial biopsy specimens from a subset of study participants showed cyclosporine reduced markers of inflammation and immune reactivity and increased goblet cell density.
In the flow cytometric studies performed in the European trials, analyses of specimens obtained after 3, 6, and 12 months of treatment showed that cyclosporine, but not vehicle, reduced the expression of the inflammatory markers. The most striking effect of cyclosporine was on HLA-DR, reported Dr. Baudouin.
Dr. McDonnell observed that widespread experience with cyclosporine, which can only be gained after marketing, will help answer the important question of how this drug may be optimally used in the management of dry eye.
"We will be interested to see whether intervention to interrupt the inflammatory process early on may prevent damage to the lacrimal gland and ocular surface that are characteristic of long-standing dry eye," he said.
Dr. McDonnell acknowledged Ste-phen Pflugfelder, MD, of Miami and Michael Stern, MD, of Irvine, CA, for their research in the use of cyclosporine therapy.
Dr. McDonnell is a consultant for Allergan, which sponsored the clinical trials
Sample Study:
Announcement for Cyclosporine Dry Eye Study
The Cornea and External Disease Service at UC Irvine is recruiting
patients with dry eye disease for a clinical trial. The purpose of
this study is to evaluate the effectiveness and safety of non
preserved Cyclosporine eye drops used twice daily for up to twelve
months in patients with moderate to severe dry eye. This is a
multi-center, randomized investigator masked, parallel group
comparison involving two treatment groups. Patients who meet the
inclusion criteria will be randomized to receive either Restasis
(Cyclosporine 0.05 % ophthalmic emulsion) or an artificial tear
(Refresh).
Minimum Study requirements:
* Eligible participants should have moderate to severe dry eye
disease
* Using artificial lubricating eye drops 4 or more times a day.
* They should be free of acute or serious illness
* Have not used ophthalmic or oral cyclosporine during the last three
years.
* Also, they will not be able to wear contact lenses for the duration
of the study.
Qualifying patients receive one of the two treatments being compared
for the first three months. At the end of three months period,
patients will be given a choice. They can either end their
participation in the study or they can continue in the study for the
next nine months and all patients will be receiving cyclosporine 0.05%
twice daily.
Someone on the rosacea group who participated in a study.
Cyclosporine dry eye Search: Click links for Abstracts:
| 1: | Robert PY, Leconte V, Olive C, Ratsimbazafy V, Javerliat M, Adenis JP. | Related Articles |
| 2: | Brignole F, Pisella PJ, De Saint Jean M, Goldschild M, Goguel A, Baudouin C. | Related Articles |
| 3: | Kunert KS, Tisdale AS, Stern ME, Smith JA, Gipson IK. | Related Articles |
| 4: | Nelson JD, Helms H, Fiscella R, Southwell Y, Hirsch JD. | Related Articles |
| 5: | Turner K, Pflugfelder SC, Ji Z, Feuer WJ, Stern M, Reis BL. | Related Articles |
| 6: | Stevenson D, Tauber J, Reis BL. | Related Articles |
| 7: | Brignole F, Pisella PJ, Goldschild M, De Saint Jean M, Goguel A, Baudouin C. | Related Articles |
| 8: | Sall K, Stevenson OD, Mundorf TK, Reis BL. | Related Articles |
| 9: | Gao J, Schwalb TA, Addeo JV, Ghosn CR, Stern ME. | Related Articles |
| 10: | Stern ME, Beuerman RW, Fox RI, Gao J, Mircheff AK, Pflugfelder SC. | Related Articles |
| 11: | Sullivan DA, Edwards JA. | Related Articles |
| 12: | Palmer RM, Kaufman HE. | Related Articles |
| 13: | Gunduz K, Ozdemir O. | Related Articles |
| 14: | Kaufman HE. | Related Articles |
Interestingly immunosuppressant cyclosporine when taken systemically can cause/worsen rosacea:
| Tidsskr Nor Laegeforen 1999 Oct 20;119(25):3789-92 | Related Articles, |
| J Am Acad Dermatol 1992 Nov;27(5 Pt 2):825-8 | Related Articles |
DO YOUR OWN RESEARCH AT:
Search the Web at http://www.google.com/ or http://www.metacrawler.com
or NewsGroups at http://www.deja.com
Or PubMed/Medline at http://www.ncbi.nlm.nih.gov/entrez
or Medline at http://www.medscape.com
