Management of inflammation in dry eye disease: Recommendations from a European panel of experts

Abstract

Introduction Early initiation of anti-inflammatory therapies is recommended for dry eye disease (DED) to break the vicious cycle of pathophysiology. However, there is limited guidance on how to implement topical ciclosporin (CsA) and corticosteroid treatment into clinical practice. This expert-led consensus provides practical guidance on the management of DED, including when and how to use topical CsA. Methods A steering committee (SC) of seven European DED experts developed a questionnaire to gain information on the unmet needs and management of DED in clinical practice. Consensus statements on four key areas (disease severity and progression; patient management; efficacy, safety and tolerability of CsA; and patient education) were generated based on the responses. The SC and an expanded expert panel of 22 members used a nine-point scale (1 = strongly disagree; 9 = strongly agree) to rate statements; a consensus was reached if ≥75% of experts scored a statement ≥7. Results A stepwise approach to DED management is required in patients presenting with moderate corneal staining. Early topical CsA initiation, alone or with corticosteroids, should be considered in patients with clinical risk factors for severe DED. Patient education is required before and during treatment to manage expectations regarding efficacy and tolerability in order to optimise adherence. Follow-up visits are required, ideally at Month 1 and every 3 months thereafter. Topical CsA may be continued indefinitely, especially when surgery is required. Conclusion This consensus fills some of the knowledge gaps in previous recommendations regarding the use of topical corticosteroids and CsA in patients with DED.

New Korean Guidelines for the Diagnosis and Management of Dry Eye Disease

“…TFOS DEWS II management reported that many treatment options for dry eye are poorly supported by level I studies [ 6 ]. Nevertheless, environmental and dietary modifications, elimination of offending factors, artificial tears, ointment, topical agents including corticosteroids, secretagogues, immunomodulators, and blood derivatives, lid hygiene, warm compress, punctal occlusion, IPL, and thermal pulsation therapy, etc., are helpful for dry eye patients [ 6 , 8 , 9 , 30 ]. Previous treatment guidelines by the KCDSG presented a stepladder approach according to severity level [ 9 ].…”

Dry eye disease management

“…Patients with persistent inflammation of the ocular surface may require immune modulating agents such as ciclosporin63637 or tacrolimus 383940 to avoid long term use of topical steroids. Both these treatments have been inconsistently reported to induce long lasting symptom improvement and may be safely used for prolonged periods 6414243. A recent randomised controlled trial comparing the efficacy of topical ciclosporin versus tacrolimus for dry eye disease demonstrated equivalency between the two 44.…”

Therapeutic Targets in the Management of Dry Eye Disease Associated with Sjögren’s Syndrome: An Updated Review of Current Insights and Future Perspectives

“…A recent study by Fondi K et al [ 63 ] demonstrated that eye drops with a combination of hydrocortisone and ciclosporin A improved patients‘ symptoms and might be beneficial for long-term and improved vision quality among SS DED patients. In addition, patients’ tolerability is critical in choosing the type of corticosteroid to be used in managing DED symptoms [ 58 , 64 ].…”