Pflugfelder, S.C. "Perspective
- Anti-inflammatory Therapy for Dry Eye." AJO, February 2004.
"Corticosteroid therapy has been reported to improve
both signs and symptoms of dry eye in several clinical studies.
In a retrospective clinical series, topical adminstration of
a 1% solution of nonpreserved methylprednisolone, given three
or four times daily for 2 weeks to patients with Sjogren syndrome
KCS, provided moderate to complete relief of symptoms in all
patients. This therapy was effective even for patients suffering
from severe KCS who had no improvement from maximum aqueous
enhancement therapies. A prospective, randomized clinical trial
compared the severity of ocular irritation symptoms and corneal
fluorescein staining in two groups of patients, one group treated
with topical nonpreserved methlyprednisolone for 2 weeks followed
by punctual occlusion (group 1) and another group receiving
punctual occlusion alone (groups 2). After 2 months of therapy,
80% of patients in group 1 and 33% of patients in group 2 had
complete relief of ocular irritation symptoms. No corticosteroid-related
complications were observed over this study period. Taken together,
these studies indicated that topical corticosteroids produced
a significant improvement in the severity of keratitis sicca."
"It is reasonable to consider anti-inflammatory therapy
for patients using artificial teams who continue to have clinically
detectable ocular surface disease, particularly if inflammatory
signs (for example, conjunctival redness) and irritation symptoms
are present. Several agents have been identified that inhibit
inflammatory mediators and mechanisms in dry eye disease. Among
the treatment options, topical corticosteroids appear to have
the most rapid onset of action. They appear to be most appropriate
for short-term pulse therapy (2 to 4 weeks) to minimize corticosteroid-related
side effects. They can be used concomitantly with cyclosporin
A, a drug that may require several weeks to produce a clinical
therapeutic effect and up to 6 months for maximum improvement."
M&T Commentary: This nice "perspective" article
does indeed give a good perspective on anti-inflammatory approaches
to dry eye. We encourage you to read the entire article.
A therapeutic option to consider: If you are considering anti-inflammatory
for a dry eye patient, try Lotemax 4 times a day for a week
or two, then twice daily for a week or two. If the patient
was considerably improved, then start Restasis for a few months.
We generally continue the Lotemax once or twice daily concurrent
with Restasis for a month, since Restasis is a slow onset drug.
How long do we keep patients on Restasis? No one really knows.
We are currently experimenting with once daily therapy after
six months at bid. It generally takes less drug to maintain
an effect than to achieve an effect.
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