Benefits and side effects of cyclosporine a 0.05% eye drops in dry eye diseases

ObjectivesTo know the effect of topical cyclosporine A 0.05% eye drops in dry eye disease and evaluate its side effects. Materials and methods30 cases, above age of15 year, of dry eye syndrome were included. Grading were doneas following eight symptoms, chronic sandy-gritty irritation, persistent dryness, foreign body sensation, scratching and burning, watery eyes, photophobia, itching and transient blurring of vision. The signs noted in cases of dry eye are tear breakup time and schirmer value. Cyclosporine A 0.05% ophthalmic emulsioneye drop used 12 hourly. Follow up of patients on after 15 days, every month for 3 months then after 6 months. ResultsIn 30 cases, malefemale ratio were 5:1. According tosymptoms, 50% mild, 30% moderate and 20% were severe, andaccording to signs 46.66%mild,33.33% moderate, and 20.00% were severe. After cyclosporine a treatment 20 became normal, 8 partially improved and 2 no improvement in symptoms while 20 became normal, 9 partially improved and1patient showed no improvement in signs. Local side effect likeburningin 23.33%, discharge in 60.66%, foreign body sensation in 13.33%, stinging in 13.33%, conjuctival hyperemia in 20% and visual disturbance in 6% eyes. ConclusionsTopical cyclosporine A 0.05% eye drop twice daily in dry eye diseases improve symptom as well as signs (schirmer”s value and tear breakup time) with minimal tolerable local side effects. KeywordsCyclosporine A, Dry Eye, Photophobia, Tear Breakup Time,Schirmer’s Test. ......................................................................................................................................................


Introduction
In 2003, cyclosporine (CsA) ophthalmic emulsion 0.05% was the first Food and Drug Administration (FDA)-approved prescription medication (Restasis®, Allergan, Irvine, CA, USA) for dry eye disease (DED), as well as the first to modify disease [1]. DED is a widespread and challenging disorder to manage, largely due to its multifactorial causes, chronic nature, need for patient compliance, and limited diagnostic and treatment options. It is the most common form of chronic ocular surface disease [2].
Dry eye syndrome also known as kerato conjunctivitis siccarepresenting foreign body sensation, grittiness, burning mild congestion, puffiness of eyelids. There are many reason for dry eye. With age, there is a natural decrease in the tear volumeand our environment. Dry eye is increased due to increasing use of contact lens., abuse of eye drops and some systemic medicines for e.g. anti-depressants, decongestants, antihistaminics, antihypertensives, oral contraceptives decongestants, diuretics, tranquilisers, among others lasik is another contributor. Association with systemic disorders like rheumatoid arthritis, diabetes, thyroid abnormalities, asthma should be looked into. Dry eye patients develop many eye complication which may even leads to blindness if not treated property and society may suffer manpower and economic losses.
Diagnosis of a case of dry eye is based on the staining pattern, schirmer's test, Slit lamp examination, and tear film studies, and chemical analysis of tear film.
An arsenal of treatment options exists for DED. 3 They include the following: 1. Lubricants, including artificial tears, gels, ointments, inserts.

Original Research Article
While topical corticosteroids are effective in breaking the cycle of inflammation, their known side effects, such as ocular hypertension, cataract, decreased wound healing, and predisposition to infection limit chronic use [5].
Alternatively, topical Cs A has a favorable risk-benefit profile for chronic use. most common side effect of CsA is ocular burning. 6 Other side effects of CsA include blurred vision, ocular itching, conjunctival hyperemia, discharge, foreign body sensation, and stinging [7].

Aims and Objectives
The aim of this study is to know the effect of topical Cyclosporine A 0.05% eye drops in dry eye disease and evaluate its side effects.

Material and Method
The present study was conducted in the department of Ophthalmology SRG Hospital & Medical college Jhalawar From January to July 2017. Dry eye syndrome patients above 15 year age included and pregnant and nursingmother and young children, patients Allergic to Cyclosporine are Excluded. grading was done as following symptoms. According to these signs cases were divided into mild. moderate and severe group.Cyclosporine A 0.05% ophthalmic emulsion is an immunomodulator that have been effective in treating inflammation in dry eye, eye drop is used 12 hourly.
Follow up Criteria-After 15 days. For every month for 3 month then after 6 months.

Observations
Grading of dry eye patients.

Discussion
Till now we are using tear conservative and tear substitutes for the treatment of dry eyes conventionally. But recent studies shows there is a chronic immune mediated inflammatory process which play an essential role in the pathogenesis of dry eye. The drug cyclosporine A is an established immune modulating and as a treatment for a variety of auto-immune diseases.
This Immuno modulating property of Cyclosporine A effect the inflammatory cascade of ocular surface disease (dry eye) and normalize the tear production and tear film stability.
In our study two patients (According to Symptoms) and one patient (AccordingSigns) failed to respond to cyclosporine Aeye drop. It might be due to the long term (more than 4 years of and on) use of the topical steroid drops.

Conclusion
So it is concluded that topical cyclosporine 0.05% eye drop twice daily in dry eye diseases improve symptom as well as signs (schirmer"s value and Tear breakup time) with minimal tolerable local side effects.
This short study was done with limited resources available at Jhalawar Hospital.