NEW YORK (Reuters Health) – Eye drops containing lubricants, corticosteroids, cyclosporine, or autologous serum improve dry eye symptoms associated with Sjögren’s syndrome (SS), according to a literature review. Evidence also showed some benefit from plugging the tear duct and from systemic drugs that stimulate saliva and tear production.
On the other hand, topical nonsteroidal anti-inflammatory medications (NSAIDs) can damage the cornea, leading the group at Johns Hopkins Institutions in Baltimore, Maryland, to oppose this drug class for SS sicca syndrome. Data were too weak to support use of dietary supplements or systemic immunomodulatory agents.
However, studies were small and of short duration, and none of the reviewed therapies actually changed the disease course, the authors report in Ophthalmology published online April 4th.
To conduct an outcomes analysis, first author Dr. Esen Karamursel Akpek and colleagues searched PubMed and the Cochrane Collaboration database for prospective, comparative trials of dry eye therapies published between 1975 and 2010. The 62 studies they identified each included at least 10 patients with SS.
Four trials looked at topical lubricants (sodium hyaluronate, hydroxypropyl cellulose inserts plus saline or oxypropyl methylcellulose, or aluminum sucrose sulfate). Results showed improvements in symptoms and in objective signs of dry eye, such as tear film breakup time and conjunctival staining.
One trial of short-term pulse topical methylprednisolone showed symptom relief and objective improvements. In four trials of cyclosporine, one trial demonstrated symptom improvement; one showed better objective test results; and in one trial, conjunctival biopsies showed decreases in activated lymphocytes.
However, in a trial of NSAIDs, diclofenac caused worse corneal staining.
In three of four trials, autologous serum or umbilical cord serum eased the ocular discomfort, and one trial showed better results of objective tests.
Three trials of pilocarpine all indicated significant symptomatic improvement of dry eye. In four trials of cevimeline — an acetylcholine derivative – three indicated subjective improvement. However, secretagogues trouble many patients with their side effects.
The two studies of punctual plugs both showed symptomatic and objective improvement. The authors say that about a third of these plugs become dislodged, suggesting that permanent surgical closure may be an option to consider.
These trials involved hydroxychloroquine, rituximab, anti-tumor necrosis factor agents, D-penicillamine, mycophenolic acid, interferon alpha-2, and oral corticosteroids. These treatments, while relieving systemic SS symptoms, do not help dry eye.
“Unfortunately,” Dr. Akpek’s team concludes, “the current literature includes almost exclusively short-term studies with small sample sizes.” Clearly, more research is required.
Ophthalmology
