Skip to main content
Log in

Efficacy of topical cyclosporine for the treatment of ocular rosacea

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

This study was designed to compare the efficacy of cyclosporine ophthalmic emulsion 0.05% with an artificial tear solution for the treatment of rosacea-associated eyelid and corneal pathology.

Methods

Double-masked, randomized, 3-month clinical trial of 37 patients with rosacea-associated eyelid and corneal changes (defined as lid margin telangiectasia, meibomian gland inspissation, and/or fullness of the lid margin). All findings were standardized and compared to photographs for grading.

Results

There was a statistically significant increase in Schirmer (with anesthesia) scores of 2.7±2.2 mm after 3 months of treatment in the topical cyclosporine group (P<0.001), compared with a mean decrease of −1.4±4.6 mm (P=0.271) in the artificial tears group. The mean tear break-up time score significantly improved in the topical cyclosporine group (mean increase of 3.56±1.5 seconds, P<0.001), but worsened in the control group, although this change was not significantly significant (mean decrease of −0.04±1.6 seconds, P=0.929). The topical cyclosporine group exhibited a significantly greater mean reduction in corneal staining scores (−1.3±0.53) compared with the control group (−0.2±0.83; between groups P<0.001). The topical cyclosporine group had a greater improvement in Ocular Surface Disease Index scores than those using artificial tears (P=0.022). Limitations of the study included an older, predominantly Caucasian patient population and short trial length.

Conclusions

Topical cyclosporine 0.05% is more effective than artificial tears for the treatment of rosacea-associated lid and corneal changes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ghanem VC, Mehra N, Wong S, Mannis MJ. The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics. Cornea. 2003;22:230–233.

    Article  PubMed  Google Scholar 

  2. Marmion VJ. Tetracyclines in the treatment of ocular rosacea. Proc R Soc Med. 1969;62:11–12.

    CAS  PubMed  Google Scholar 

  3. Akpek EK, Merchant A, Pinar V, Foster CS. Ocular rosacea: patient characteristics and follow-up. Ophthalmology. 1997;104:1863–1867.

    CAS  PubMed  Google Scholar 

  4. Bowman RW, McCulley JP, Jester JV. Meibomian gland dysfunction and rosacea. In: Pepose J, Holland G, Wilhelmus K, eds. Ocular Infection and Immunity. St. Louis: Mosby-Year Book; 1996:334–343.

    Google Scholar 

  5. Kocak-Altintas AG, Kocak-Midillioglu I, Gul U, et al. Impression cytology and ocular characteristics in ocular rosacea. Eur J Ophthalmol. 2003;13:351–359.

    CAS  PubMed  Google Scholar 

  6. Barton K, Monroy DC, Nava A, Pflugfelder SC. Inflammatory cytokines in the tears of patients with ocular rosacea. Ophthalmology. 1997;104:1868–1874.

    CAS  PubMed  Google Scholar 

  7. Bron AJ. Diagnosis of meibomian gland disease and MKC: what is really meant by meibomian inflammation? Am J Ophthalmol. 2005;139:S23–S24.

    Article  Google Scholar 

  8. Macsai M. The role of Omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis). Trans Am Ophthalmol Soc. 2008;106:336–356.

    PubMed  Google Scholar 

  9. Jansen T, Plewig G. Rosacea: classification and treatment. J R Soc Med. 1997;90:144–150.

    CAS  PubMed  Google Scholar 

  10. Wilken J, Dahl M, Detmar M, et al. Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. J Am Acad Dermatol. 2002;46:584–587.

    Article  Google Scholar 

  11. Randleman JB, Loft E, Song CD. Ocular rosacea. Available at: http://www.emedicine.com/oph/topic115.htm. Accessed Nov. 7, 2006.

  12. Donnenfeld E, Pflugfelder SC. Topical ophthalmic cyclosporine: Pharmacology and clinical uses. Surv Ophthalmol. 2009;54:321–338.

    Article  PubMed  Google Scholar 

  13. Sall K, Stevenson OD, Mundorf TK, Reis BL. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. Ophthalmology. 2000;107:631–963. Erratum in: Ophthalmology. 2000;107:1220.

    Article  CAS  PubMed  Google Scholar 

  14. Restasis [package insert]. CA: Allergan Inc.; 2004.

  15. Kunert KS, Tisdale AS, Stern ME, et al. Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Arch Ophthalmol. 2000;118:1489–1496.

    CAS  PubMed  Google Scholar 

  16. Doan S, Gabison E, Gatinel D, Duong M-H, Abitbol O, Hoang-Xuan T. Topical cyclosporine A in severe steroid-dependent childhood phlyctenular kerato-conjunctivitis. Am J Ophthalmol. 2006;141:62–66.

    Article  CAS  PubMed  Google Scholar 

  17. Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000;118:615–621.

    CAS  PubMed  Google Scholar 

  18. Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003;22:640–650.

    Article  PubMed  Google Scholar 

  19. Driver PJ, Lemp MA. Meibomian gland dysfunction. Surv Ophthalmol. 1996;40:343–367.

    Article  CAS  PubMed  Google Scholar 

  20. Zengin N, Tol H, Gunduz K, et al. Meibomian gland dysfunction and tear film abnormalities in rosacea. Cornea. 1995;14:144–146.

    Article  CAS  PubMed  Google Scholar 

  21. Turner K, Pflugfelder SC, Ji Z, et al. Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporine ophthalmic emulsion. Cornea. 2000;19:492–496.

    Article  CAS  PubMed  Google Scholar 

  22. Perry HD, Wittpenn JR, D’Aversa G, Donnenfeld ED. Topical cyclosporine 0.05% for the treatment of chronic, active ocular rosacea. Poster presented at: Annual Meeting of the Association for Research in Vision and Ophthalmology; May 3, 2005; Ft. Lauderdale, Florida, USA.

  23. Perry HD, Doshi-Carnevale S, Donnenfeld ED, et al. Efficacy of commercially available topical cyclosporine A 0.05% in the treatment of meibomian gland dysfunction. Cornea. 2006;25:171–175.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Barry A. Schechter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schechter, B.A., Katz, R.S. & Friedman, L.S. Efficacy of topical cyclosporine for the treatment of ocular rosacea. Adv Therapy 26, 651–659 (2009). https://doi.org/10.1007/s12325-009-0037-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-009-0037-2

Keywords

Navigation