From the Guidelines
Diagnosing Keratoconjunctivitis Sicca (KCS), also known as dry eye syndrome, involves a comprehensive evaluation, including a thorough medical history, slit-lamp examination, and specialized tests such as the Schirmer test and tear film break-up time assessment 1.
Diagnostic Criteria
The diagnostic criteria for KCS include a constellation of findings from multiple tests, as no single test is adequate for establishing the diagnosis 1.
- A thorough medical history to identify underlying conditions that may be contributing to dry eye symptoms
- Slit-lamp examination to assess the ocular surface and tear film
- Specialized tests such as the Schirmer test and tear film break-up time assessment to evaluate tear production and stability
Treatment Options
Treatment for KCS may include:
- Artificial tears, such as preservative-free sodium hyaluronate 0.1% or carboxymethylcellulose 0.5%, used 2-4 times daily as needed 1
- Prescription medications like cyclosporine 0.05% ophthalmic emulsion (Restasis) or lifitegrast 5% ophthalmic solution (Xiidra) may be prescribed, with a typical dosing regimen of one drop twice daily for a minimum of 3 months 1
- Punctal plugs may be inserted to conserve tears
- Omega-3 fatty acid supplements, such as flaxseed oil 1000mg or fish oil 1000mg, may be recommended to reduce inflammation For patients with underlying Sjögren's syndrome, treatment may also involve managing the underlying systemic immune disorder, and a multidisciplinary approach with a rheumatologist may be necessary 1. In cases of refractory or severe ocular dryness, topical short-term therapeutic approaches, such as immunosuppressive-containing drops or serum eye drops, may be considered, but should be used with caution and under the guidance of an experienced oiterary ophthalmologist, due to potential adverse events 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Mechanism of Action Cyclosporine is an immunosuppressive agent when administered systemically. In patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca, cyclosporine emulsion is thought to act as a partial immunomodulator. INDICATIONS AND USAGE RESTASIS® ophthalmic emulsion is indicated to increase tear production in storming patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca.
The diagnostic criteria for Keratoconjunctivitis Sicca (KCS) are not explicitly stated in the provided drug labels. The treatment options for KCS include cyclosporine ophthalmic emulsion to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with KCS, as stated in the indications and usage section of the drug label 2 and 2. Key points to consider when treating KCS with cyclosporine ophthalmic emulsion:
- Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs.
- No increase in bacterial or fungal ocular infections was reported following administration of RESTASIS® 2.
From the Research
Diagnostic Criteria for Keratoconjunctivitis Sicca (KCS)
- KCS, also known as dry eye disease, is characterized by ocular discomfort and visual disturbances that decrease quality of life 3
- Diagnostic criteria include:
- Ocular Surface Disease Index (OSDI) scores ranging from 0 to 100, with higher scores indicating greater symptom severity 3
- Conjunctival staining score ranging from 0 to 6, with higher scores indicating more severe damage to the ocular surface 3
- Corneal staining score ranging from 0 to 15, with higher scores indicating more severe damage to the ocular surface 3
- Tear break-up time (seconds between a blink and gaps in the tear film), with lower values indicating more severe signs 3
- Schirmer's test (length of wetting of paper strips placed on the lower eyelid), with lower values indicating more severe signs 3, 4
Treatment Options for KCS
- Topical cyclosporine treatment has been shown to be effective in reducing symptoms and signs of dry eye disease, with some patients experiencing long-term resolution of symptoms 5, 6, 7
- Sodium hyaluronate-containing artificial tears have been shown to improve ocular surface damage and reduce symptoms of dry eye disease 4, 6
- Combination therapy with topical cyclosporine and sodium hyaluronate has been shown to be effective in improving tear film stability, dry eye discomfort, and ocular pain in patients with post-refractive surgery dry eye disease 6
- Omega-3 fatty acid supplementation has been studied as a potential treatment for dry eye disease, but results have been mixed, with one study finding no significant difference in outcomes between patients receiving omega-3 fatty acid supplements and those receiving a placebo 3