What is the recommended treatment for inflammatory dry eye?

From the Guidelines

The most effective treatment for inflammatory dry eye is topical cyclosporine 0.05% (Restasis) applied twice daily, as it has been shown to improve tear production and reduce inflammation in patients with moderate to severe dry eye 1. This recommendation is based on the most recent and highest quality study, which demonstrated a statistically significant 10-mm increase in Schirmer test results compared with vehicle at 6 months for those patients whose tear production was presumed to be decreased because of ocular inflammation 1. Some key points to consider when treating inflammatory dry eye include:

• The use of artificial tears without preservatives several times daily for symptom relief
• Topical anti-inflammatory medications, such as cyclosporine or lifitegrast, as the mainstay of treatment
• Short-term use of topical corticosteroids, such as loteprednol 0.5% or fluorometholone 0.1%, to quickly reduce inflammation
• Oral omega-3 fatty acid supplements to reduce inflammation systemically
• Warm compresses and gentle lid massage to improve meibomian gland function
• Environmental modifications, such as using a humidifier and avoiding direct air flow to the eyes, to support treatment It's worth noting that lifitegrast (Xiidra 5%) is also an effective treatment option, as it has been shown to improve signs and symptoms of dry eye over a period of 3 months 1. However, the long-term effects of lifitegrast are unknown, and cyclosporine has been shown to be effective in improving tear production and reducing inflammation in patients with moderate to severe dry eye 1.

From the FDA Drug Label

Loteprednol etabonate ophthalmic suspension is indicated for the treatment of steroid-responsive inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial punctate keratitis, herpes zoster keratitis, iritis, cyclitis, selected infective conjunctivitides, when the inherent hazard of steroid use is accepted to obtain an advisable diminution in edema and inflammation The recommended treatment for inflammatory dry eye is loteprednol etabonate ophthalmic suspension 2.

• The dosage is one to two drops into the conjunctival sac of the affected eye four times daily 2.
• Key considerations: loteprednol etabonate should not be used in patients who require a more potent corticosteroid for this indication 2.

From the Research

Treatment Options for Inflammatory Dry Eye

• Loteprednol etabonate is a recommended treatment option for inflammatory dry eye, as it has been shown to be effective in reducing signs and symptoms of the condition 3, 4, 5, 6.
• The use of loteprednol etabonate 0.5% ophthalmic suspension has been evaluated in several studies, and it has been found to be safe and well-tolerated, with minimal effects on intraocular pressure 3, 6.
• Loteprednol etabonate 0.25% ophthalmic suspension is also an FDA-approved treatment modality for the short-term treatment of the signs and symptoms of dry eye, and it has been found to be effective in reducing inflammation and improving symptoms 5.

Combination Therapies

• The combination of loteprednol etabonate and tobramycin has been evaluated for the treatment of ocular surface inflammatory conditions, and it has been found to be safe and effective 7.
• The use of loteprednol etabonate before the initiation of topical cyclosporine therapy has been found to reduce stinging and provide more rapid relief of dry eye signs and symptoms 6.

Key Findings

• Loteprednol etabonate has been found to be effective in reducing inflammation and improving symptoms in patients with dry eye disease, particularly those with a more pronounced inflammatory component 3, 4, 5, 6.
• The medication has a low propensity to cause corticosteroid-related adverse effects, such as elevated intraocular pressure, making it a safe treatment option for patients with dry eye disease 3, 4, 6.